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OCT 30/2014

Enabling NHS organisations to become mutuals: a step forward?

One of the key themes of the current NHS reforms is the increasing focus on allowing healthcare professionals to have a greater say in the development and planning of the services they deliver.

There is a growing sentiment within the healthcare sector that doctors and nurses should be empowered to make key organisational decisions that reflect their experiences of working on the frontline, rather than delegating such considerations to middle managers and a bureaucratic leadership structure.

In July, a report was published by the King's Fund that suggested this concept could be taken to the next level by embracing the public service mutuals model - a move that may enhance engagement and ultimately lead to better outcomes for patients.

How mutuals work
Public service mutuals are organisations that have formally split from the rest of the public sector, operating semi-independently but continuing to deliver public services. Typically, they are formed by public workers who believe they can run their organisations more efficiently in terms of costs and quality, or who wish to take their service in a different direction to fulfil a market need.

Free from direct government control, they are intended to allow staff to call the shots and deliver services in the way they know works best, while sharing in the rewards of success.

Examples of this model include the City Health Care Partnership, formed by ex-NHS Hull employees in 2010, and Bromley Healthcare, established in April 2011 to provide out-of-hospital health services in Bromley.

The potential benefits of mutuals
According to the King's Fund research, there can be a number of considerable benefits to embracing this model, primarily in terms of staff engagement levels. Testimony from leaders and staff working for mutual organisations revealed that they can create a strong sense of ownership and empowerment, leading to better organisational performance.

This is a key issue, as there is voluminous evidence that high levels of staff engagement can lead to lower mortality rates and better patient experiences - as well as a reduced occurrence of sickness absence and staff turnover.

Given that a lack of engagement was considered to be a key cause of the much-publicised care failings that took place at the Mid-Staffordshire NHS Foundation Trust, helping healthcare professionals to feel more involved in decision-making has become a high-priority issue in the NHS - one that mutuals could contribute to solving.

Moving forwards
As such, the King's Fund report recommended that greater freedom be extended to NHS organisations - including hospitals - to become mutuals on a voluntary basis, while suggesting that a programme of pathfinder schemes could be launched to obtain more evidence about the benefits of mutuals, and whether it would be prudent to adopt the model on a larger scale.

It also suggested that the regulatory system governing the NHS be relaxed, allowing more responsibility to be devolved to local NHS leaders to bring about improvements in care. This way, staff will be empowered to make key decisions and planning contributions, even without fulling committing to the mutuals system.

Study author and King's Fund chief executive Chris Ham said: "The evidence that more engaged staff deliver higher quality care is compelling - a simple truth that should be acted on by all NHS organisations." 

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