“It is important that the social enterprise is shaped as a business but it is merely a vehicle to make those big changes to public services.”

www.navigocare.co.uk

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In April 2011, North East Lincolnshire mental health services became a not-for-profit social enterprise called NAViGO. NAViGO is currently commissioned by the NHS to deliver the North East Lincolnshire mental health services. Their focus is on care delivered in real-life settings – and the integration of care with the daily lives of our users. Their philosophy is to develop services in close working relationships with service users and their families and carers.

Tukes is NAViGO’s highly innovative employment and training scheme. It was established in July 2003 to provide training and employment opportunities to people who have little or no previous training, qualifications or work experience due to mental health problems. Tukes aims to enable people to gain new skills, increasing confidence, and motivation and counteracting social exclusion within the labour market. Tukes successfully operates five cafés, external catering services, external cleaning services, conference facilities, delivery of NHS cleaning and catering contracts, laundry, property maintenance, horticultural services and a second hand shop; all in North East Lincolnshire.

Kevin Bond interview:

Why did you spin out into a social enterprise?

Social enterprise formation allowed us to enshrine service user’s rights and set up a truly accountable local organisation with both staff and service users having equal rights. We knew in the present climate we would have to save money and wanted to ensure it was saved from bureaucracy, infrastructure and management, not services that related directly to service users. We wanted these significant savings to have the least possible effect on the services people got. Inside the NHS we felt that savings were unlikely to be made in this way as the NHS has somewhat become overly populated by posts that have no direct relationship with the public who are served and often these roles hold much of the decision making power. So it seemed like a logical step to spin out into a social enterprise, and the Right to Request provided the appropriate opportunity to do so.

At what point did you decide NAViGO was going to spin out?

25 years ago I thought it would be a good idea to do something in mental health care that was more locally accountable, with staff and service users ‘in charge’; however that seemed a pipe dream at the time. 5/6 years ago, I considered that concept again and spoke to colleagues, but the idea didn’t really fit with the NHS policy at the time and it looked like it would be a difficult manoeuvre. In 2010, the Right to Request came about and provided a perfect opportunity to seriously suggest it to the staff and service users.  In 2010, the Right to Request came about and provided a perfect opportunity to seriously suggest it to the staff and service users.

How did you spin out? Did you involve your staff in the process?

We approached the idea a while back. We ‘the managers’ and service user/carers involved in management infrastructure at the time did not simply just decide to do it; we had a poll of staff , service users and carers and got overwhelming support for the idea from them. The idea was also suggested to the independent user/care forum and TUKES members so we held a vote on whether or not to become an independent social enterprise (once the pros and cons had been weighed). In the end, a large majority of staff and service users voted for the spin out. 75% of staff voted for the spin out model, despite the regional and national trade unions being against the concept at the time. In addition, approximately 98% of service users voted for it; a significant display of support.

How have you involved service users in the process?

We have always had a tradition of having service users and carers on our Board and Tukes is largely run by the service users themselves. Therefore the idea of empowering service users was already embedded in the preparatory work we had done prior to becoming a social enterprise. During the transitional phase in addition to their vote on becoming a social enterprise, we asked the service users how they thought the services could be improved; there was a consensus that the environment itself also needed improving. Service users are also on our interview panels, and have been for at least nine years; so they have a lot of say in how the social enterprise is run as they are involved in hiring the people that run it.

How is the social enterprise structured?

Our design as a social enterprise is quite novel in itself. NAViGO is a CIC with two types of membership: staff membership and community membership (service users, carers and people with genuine interest in mental health in the local community). Our Board has both staff members and community members (which includes some service users), and all members have equal voting rights. There are also professional directors in the medical, finance and operations profession, a local council member and a GP representative on the Board. As chief executive of NAViGO I am also electable and recallable to some extent; it is written into the articles. Every four years the members can decide whether I should be kept on; if not the Board would be tasked to find a suitably qualified and experienced candidate as a replacement.

Was spinning out a top-down approach in NAViGO?

If you have done a Right to Request with 20 people you can all get together and chat about it, but when there are 500+ staff it has to be a top-down approach as no one at the bottom could push it upwards. So that is relative to the size of the organisation in some respects. The spinning-out process also required support from wider bodies such as the council as we run their social care and mental health services; so that required leadership and negotiation from the top. But this is not a game or experiment; we are all involved and have been involved with service users and understand their needs, we did what we thought was best and the staff and service users supported it. Our services operate under the premise that they would be services you would be happy for your family to have.

Do you think spinning out has to be a lengthy process?

Not necessarily; it just never existed as a real possibility for us before.

Were there any problems encountered with regard to staff perceptions of the change?

We did a huge amount in empowering service users for a long time when we were a North Lincolnshire mental Health Care Trust Plus. So the staff were aware of our views and had the opportunity to back this structure or voice their opinions. There were some negative staff; but once you discuss the issues and allow questions to be resolved then these tend to diminish and be replaced with a lot of positivity. At the beginning of the process there was a really small group of people driving it; but now everyone in the organisation gets it and understands what we are about. Our first AGM for example has just been attended by 220+ people, made up of 194 members, some partner organisations, local councillors and visitors. That is a very large interested and supportive group of people surrounding NAViGO.

How many years of work have you contracted with the NHS?

Three, but the Right to Request can prove to be problematic as this type of contract seems to be viewed in a different way from a private sector organisation. However, we will have saved nearly £3million in three years from our NHS contract by simply doing things more efficiently than we did before. So far and projecting the first two years, we have not stopped any service; indeed we have actually expanded frontline ‘services’ slightly. We have cut down on management, cut down bureaucracy and use less expensive external placements by doing more locally. If we had gone back to being a big mental health trust it would likely not nearly have been as efficient and probably detrimental. It would have been wrong for the service in this area.

Do you think you will get another NHS contract in the future?

You would hope that our reputation would precede us. The fact is we have gone from a neglected service to an award winning one, which has many top scoring indicators and national and regional exemplars, in just a few years. A possibility is that the publicity surrounding the plural provision of public services could harm us and the services locally; but it is difficult to say given the NHS reforms which are occurring and the uncertainty surrounding them.

As there has been a separation of commissioning and provision in the NHS in recent years, commissioning in mental health is also problematic for us. Many of the people with extensive mental healthcare experience are within provision and there is comparatively limited knowledge in commissioning; raising the serious threat that decisions are made by less well-informed people. NAViGO is successful and many other providers come to visit us, have training from us and take advice in areas our areas of expertise; we only hope that local commissioners will recognise this.

Why did you decide to keep the NHS branding?

Many staff members wanted to keep it. It also gives service users that reassuring label of credibility. It’s a “badge”, it still has a public message and underlines our not for profit stance. If you work in the health service it is because you work with people and you care about people.

How did you adapt to having more of a business mindset?

I hear a lot of talk in social enterprise about business, but first things first; the reason why NAViGO exists is to provide really good services to vulnerable people. It is important that the social enterprise is shaped as a business but it is merely the vehicle to make those big changes to public services. It is not a goal in itself, but helps in distributing power better. Naturally, there is less bureaucracy in an independent social enterprise than in the NHS; layers of bureaucracy slow things down. We have a greater freedom to try new things and see results delivered more quickly. That is definitely a welcome change. For example, from idea to completion, our latest Tukes-run shop took less than 6 months to complete; we reflect that in the past this would have taken a few years to pass Boards and everything else. Ultimately the care-mentality is still there and always will be. All staff are hired with the premise that they understand mental health issues; regardless if they are involved in frontline care or not.

Do you think NAViGO can be self sustaining?

Yes in many respects it can. We started with some basic core funding, but now the majority of it is self funded. This is because Tukes saves us money by providing day services for service users; maintenance of our facilities and an easy route to new staff and training programmes. Without Tukes, NAViGO wouldn’t necessarily be able to afford to keep the premises running at such a high standard. For example, when in the NHS, simply getting a shower fixed required different forms and papers and had taken months. Independently, it can just get done, and even better it can be done by Tukes. So we have twice the effect for the same money; with contracts done well and people with mental health problems getting real work, experiences, training and qualifications. The beauty of Tukes is that now if anyone tried to take it away; there would be outcry, and it is inherently linked with NAViGO, so the whole organisation is pretty self-defending at this point. The organisation is very well thought of and supported by the local community.

Do you see yourself providing services in other areas?

What we set out to do was to provide a really good service here for mental health. If we simply regarded ourselves as a business and only a business then we would branch out and get contracts across the country; but then we possibly wouldn’t pay enough attention to the people here and the service users. If what we do can really add quality to something somewhere else, we can always go out and do consultancy. I don’t necessarily want to run peoples’ services anywhere else, but I do want to try to set benchmarks for mental health services with NAViGO. Where possible, local people should have their own local services in which they can have a strong say. It is no good having little disparate bits of service run by lots of different people, it is dangerous in fact. There are still things we do that I want to sort out here. We already supervise RESPECT training internationally. We could also take Tukes wider as it is easily translated. But ultimately, we are not doing business for businesses sake. We are public servants and wish to provide a highly accountable public service, using the enterprise principles to make it more accountable, quicker and more efficient.

John Ogden-ran day services in Lincoln before with North Lincolnshire Mental Health Services and has been with NAViGO from the start.  How has the experience been for you John?

It’s been lovely, I came here as a day hospital manager in a pretty run-down service, and in the first year we had all these wonderful ideas; now we have the freedom to get on and do it. In NAViGO we always give something a go. There is not a huge plan required like in a lot of authorities; here we grow ideas by testing them out. When the ideas work we do more of them and that naturally weeds out the unsuccessful ones. Yes it can be tiring, but the definition of tiredness is that you have a passion and you have to fight to achieve your passion.

Do you have any advice for public sector organisations looking to spin out?

• Know why you are wanting to do it. It will be hard and painful, but if you really want to give better care, be innovative, spread power and influence, be more flexible and quicker to act, then it should help greatly.

• Keep your focus on what you want to achieve, don’t be seduced by the constant talk of business, you need it but it is not the goal.

• Challenge all the traditional methods of doing things. E.g. why do things like that, why not do things like this?

• Really think about all the tools you may need. For example; if you need a new site really get into planning permission, building regulations etc as you will need to learn a lot.

• People may say “You can’t do this because you need X, Y and Z”, so you need to have a supportive network of trustworthy people around you.

• If possible, social enterprises should try and help each other in areas where they lack expertise. For example, NAViGO commissioned artwork from a local SE and asked if some service users could contribute to the artwork project.

• You need to prove to staff that you are 100% behind them and supportive of them if they use different and innovative methods.

• If you are going to do this you have to be genuine and honest. You have to be committed and believe in it.