Bath moves social care and NHS services to a social enterprise

A south west council has moved its staff and those from its primary care trust into a new community interest company

The people at Sirona Care and Health certainly can’t be faulted on presentation. Sirona, its name inspired by Celtic mythology, visions of watery healing and teams of marketing advisors, burst into life on 1 October.
A social enterprise company spun out of Bath and North East Somerset council social services and the local NHS primary care trust (PCT), Sirona is charged with the provision of adult social care and health care for the area, from care homes and adult social services to community hospitals and health visitors. But while others in the vanguard of the government-backed transition to a social enterprise culture struggle with quangotastic names such as Care and Support Swindon CIC, Sirona had its eye on something with a little more pizzazz.
“We asked staff informally if they wanted something that looked like the NHS or the council, or if they wanted something that looked different,” says Sirona chief executive Janet Rowse. “They said, if you’re going to do it, let’s go for it. It’s a bit like Orange and Apple.”
Local Labour councillor Eleanor Jackson had a different view of the chosen name. In a letter to the Bath Chronicle she wrote: “The use of an 8th century East Gaulish goddess ‘demythologised’ by British missionaries” suggests that “prayer may be the only means of healing for many of us.”
Undeterred, Rowse and her colleagues at the top of Sirona went further. The 1,700 former council and NHS staff now employed by Sirona wear purple lanyards round their necks. Workers at three formerly council-run care homes also sport purple shirts with rainbow collars, a move designed to make them more approachable to dementia sufferers.
“Sometimes emotionally you hit something unexpected,” says Rowse of the new corporate identity. “Maybe it’s something to do with 90% of our staff being female, or that purple is the colour of the season, but they have coalesced behind it. When we had our launch events many of them turned up wearing purple. I’ve never seen so many purple people in my life.”
Yet while the staff may wear the colours, Sirona has been criticised for the lack of consultation over its creation. In common with other social enterprises charged with bringing reality to the government’s diktat that suppliers and providers be separated, Sirona’s emergence has been swift, little understood and largely unnoticed.
Rowse points to the year-long public debate over the creation of a social enterprise, but beyond the corridors of NHS and council management there is little evidence of any real discussion of the options beyond the creation of a social enterprise.
“It was most definitely the preferred option,” says Helen Hancox, a Royal College of Nurses regional officer for the south west. “It was social enterprise or out to the highest bidder.”
Rowse argues that the demands of efficiency trump those of democracy. “We didn’t have a ballot for the staff,” she says. “I don’t think you can run by consensus. The onus is to provide leadership and demonstrate that this is the right answer.”

Swaying Sirona
Sirona’s structure promises staff and public involvement through a membership panel which will “influence and inform” the way the organisation is run. But real power lies with the board of directors, drawn largely from the council and local PCT.
The organisation has an advantage that other nascent social enterprises lack: it has been able to build on a structure of cooperation and integration between social and healthcare providers dating back to 2009. Nevertheless, the move to place the two cultures of social care and healthcare, of council and NHS staff under one organisation has been occasionally fraught.
“Undoubtedly, NHS staff would prefer to stay in the NHS, and council staff in the council,” says Rowse. “We have tried very hard to put it in the middle.”
Some staff working in the new structure offer a different view, talking of demoralisation, a lack of consultation, and former colleagues turned into bickering enemies.
Staff unions are concerned at the prospect of terms and conditions being harmonised between NHS, council and new employees. “Harmonisation inevitably moves downwards,” says Karen Cole, regional officer for Unite. “The change to a social enterprise is going to have a big impact on collective bargaining. Previously it was national, and now it will be with individual social enterprises.”
While much of the stress can be traced to the organisational changes, the financial pressures facing the new entity also play a role. While Sirona will handle combined contracts worth £50m per year, it has to produce savings of £9m over five years. As a social enterprise, there is no dividend for shareholders, with any surplus reinvested in the company.
“Clearly it is significant,” says Rowse of the financial challenge ahead, “but if you look at other elements of the public sector it is not markedly different. The margins are small, particularly in the early years. And we start with no capital, so it is tight, but doable.”
Rowse says that there are no plans for service reduction, although she adds: “80% of our expenditure is staff, so clearly an element of savings will be headcount.” She envisions this being achieved through natural turnover.
“There is real anxiety among the staff,” says the RCN’s Hancox. “We are anxious that the social enterprises will not survive. Sirona has a five-year contract. Talking to our members, they don’t get it. And then there’s this caught in the headlights look as they realise that there isn’t a NHS safety net. If the social enterprise goes bust, nobody will come and save them. Some people may find that appealing politically, but we’re not talking about commodities, we’re talking about people.”