Bromley Healthcare

A Message from Lord Pickles and Lord Blunkett, followed by Bromley Healthcare's best practice article

The ability to listen and learn from one another has always been vital in parliament, in business and in most aspects of daily life. But at this particular moment in time, as national and global events continue to reiterate, it is uncommonly crucial that we forge new channels of communication and reinforce existing ones. The following article from Bromley Healthcare is an attempt to do just that. We would welcome your thoughts on this or any other Parliamentary Review article.

Blunkett signature Rt Hon The Lord David Blunkett
Pickles signature Rt Hon The Lord Eric Pickles

Chairman Raoul Pinnell
Nurse attending patient in
their own home
The NHS budget stands at roughly £150 billion and makes
up 23 per cent of government spending, employing
1.3 million people. At a time when the NHS faces
unprecedented demographic challenges, Bromley Healthcare
offer a different model of service delivery, one they believe will
reduce the burden on the taxpayer while improving patient care.
As a social enterprise, they aim to secure contracts from the
NHS to deliver local services. Chairman Raoul Pinnell explains
their approach and questions whether social enterprises could
become the driving force to reinvigorate the NHS.
The NHS is a centralist state monopoly that accounts for 23 per cent of government
funding. It is much loved but is a leaking bucket. Money pours in and drains away
too quickly. Budgets are overspent. This is not just because of rising demand and
ever-higher expectations of patients but also due to a lack of effective management.
However, finding solutions in the minefield of vested interests is challenging.
Politicians and civil servants developed one idea, based on introducing new
competition, in the form of mutual companies, called social enterprises. These were
owned by staff and not for profit. The hope was that they would be more efficient
than NHS-run bodies and not be able to extract profits from the taxpayer.
In 2011, some 19 NHS local community health providers, who deliver services to
people in their own homes or local clinics, gained approval to be transferred out of
the NHS and morphed into social enterprises.
»Chairman: Raoul Pinnell
»Established in 2011
»Based in the London Borough
of Bromley
»Services: Community healthcare
(e.g. nurses doing home visits)
»No. of employees: Over 1,000
»Annual patient contacts:
»70 per cent of NHS trusts
overspend their agreed budgets
Bromley Healthcare
Highlighting best practice
One of these was Bromley Healthcare.
The NHS umbilical cord had been
cut, and our team faced a brave new
world. On our first day, we were
terrified. We had been given a five-
year contract. Annual income matched
annual expenditure. We had no profit
margin, no funds from shareholders
and no savings, and no bank would
lend us money. We could go bust. This
was a very different world from being
on the inside of the NHS, where it is a
one-way bank: if you make a loss, it is
funded by the exchequer.
The penny dropped. To survive, we
needed to make a surplus. We junked
the tag of being not for profit and
replaced it with needing to make a
profit for reinvestment. We would then
use any profits to fund investments to
both improve productivity and build a
savings pot.
What did we focus on to
deliver a surplus?
We stood back and reviewed how we
did things and identified where we
could make improvements and deliver
profits for reinvestment. In tandem,
we overhauled what data we needed
to collect and how we would use
information to manage and report on
Our results were surprising. We
reduced the percentage of patients
who did not turn up for their
appointments to below five per cent.
This released capacity, which meant
that we saw more patients and
reduced waiting times. Through staff
engagement, supported by a staff
blog, we improved productivity by
increasing training, earned contractual
bonuses for achieving a range of
quality outcomes and made changes
to staff rostering and holiday planning.
With a focus on IT, we improved
efficiency by adopting the same patient
record system as GPs while introducing
a process to assist GPs in making multi-
referrals, and we also moved patient
records from paper to digital, with
nurses using iPads. We also set up and
donated to a new charity, to support
some needs that were not being met
from the public purse.
Overall, we achieved levels of patient
recommendation above 97 per cent
and good quality scores. Through
management effort, we reduced staff
vacancies, staff sickness and the use
of agency staff to below health sector
norms. We met the contractual targets
set by our commissioners. The bottom
line was that we had made profits that
were being reinvested. After seven
years, we had £5 million in cash in
Nurses dressing leg
Supporting a child to
achieve their maximum
To survive, we
need to make
a surplus
One unintended beneficiary
was the taxpayer
We demanded no financial bailouts
from the state and absorbed all
unavoidable redundancy costs.
Government liabilities for state-funded
pensions have been reduced, as 17 per
cent of staff had opted for a defined
contribution pension scheme. We also
returned £1 million to HMRC in the
form of corporation tax.
Our main contracts were extended,
but, in 2017, they were put out to
The bidding process, on all sides, was
not a trivial item. Our submission
cost us £360,000 and required us to
upload over 1,000 documents to the
Clinical Commissioning Group’s portal.
Only NHS organisations entered the
competitive bidding fray. Bizarrely,
some of them were loss-making.
For them, the cost of bidding was
just another expense borne by the
taxpayer, and they did not have to
factor in VAT and corporation tax. In
the end, in a David vs. Goliath battle,
we won the contracts for a further
seven years, in a transparent scoring
process, on both quality and price.
We are now focusing on integrating
care, with many of our health
professionals working around groups
of patients. This has led to the launch
of our centralised Care Coordination
Centre, which includes staff who
joined us under the government
apprenticeship scheme. The centre
is currently handling some 20,000
patient contacts a month.
We welcome the NHS Long Term Plan
and the implicit shift it contains from
hospital care to GP and community
services. On the other hand, however,
big government initiatives are often
launched without adequate testing,
so navigating our way through this
change, when a large amount of it is
not prescriptive and is untested, will of
course be challenging. We are ready
for this challenge, but its effects will
likely be seismic.
To date, the experience of one social
enterprise indicates that both a staff
voice that is heard and a public
service ethos are critical. The real key,
however, is a commercially literate and
accountable leadership team who work
within a given budget and understand
the consequences of financial failure
and success. Released from the tether
of institutionalised bureaucracy, they
have demonstrated that it is possible to
increase productivity, improve patient
care, make a profit for reinvestment
and reduce the burden on the
An updated profit for reinvestment
business model for social enterprises
offers a tantalisingly different solution
to the way that the challenges of
funding within the NHS could be met.
Could socially driven business
enterprises be expanded and become
disruptive innovators that reinvigorate
the NHS?
The key is a
literate and
team who
work within a
given budget
Patient in rehabilitation

This article was sponsored by Bromley Healthcare. The Parliamentary Review is wholly funded by the representatives who write for it. The publication in which this article originally appeared contained the following foreword from Rt Hon Michael Gove.

Rt Hon Michael Gove's Foreword For The Parliamentary Review

By Rt Hon Michael Gove

This year's Parliamentary Review comes at a momentous time for parliament, as we collectively determine the destiny of the United Kingdom. 

On October 31, the UK will leave the European Union. The successful implementation of this process is this government's number-one priority.

Three years after a historic referendum vote, we will deliver on the decisive mandate from the British people. Trust in our democracy depends on it. Until that final hour, we will work determinedly and diligently to negotiate a deal, one that abolishes the backstop and upholds the warm and close relationship we share with our friends, allies and neighbours in the EU. But in the event that the EU refuses to meet us at the table, we must be prepared to leave without a deal.

As the Chancellor of the Duchy of Lancaster, it is my job to lead on this government's approach, should that scenario happen. Preparing for Brexit is my department's driving mission. But while I am leading this turbocharged effort, the whole of government is committed to this endeavour.

Ministers across Whitehall are working together to ensure that every possibility is considered, every plan is scrutinised and every provision is made. A daily drumbeat of meetings means that we are holding departments accountable, so that preparations are completed on time.

The chancellor has confirmed that all necessary funding will be made available. And we have mobilised thecivil service, assigning 15,000 of our most talented civil servants to manage our exit from the EU.

We will make sure that on November 1, there is as little disruption to national life as possible. Our trade relationships will continue to thrive, thanks to agreements with countries around the world worth £70 billion. Our country will remain secure, thanks to nearly 1,000 new officers posted at our borders. And the 3.2 million EU nationals now living and working among us can remain confident, with absolute certainty, of their right to remain in the UK.

Above all, our goal is to be transparent. Soon, we will launch a public information campaign so that citizens, communities and businesses are ready and reassured about what will happen in the event of “no deal”.

In my first few weeks in this role, I have travelled to ports and tarmacs, borders and bridges, all across the UK –from the seaside of Dover to the rolling green hills of County Armagh. I have heard from business owners and border officials, farmers and hauliers. They are ready to put an end to uncertainty. And they are ready to embrace the opportunities ahead.

Our departure from the EU will be a once in a lifetime chance to chart a new course for the United Kingdom. Preparing for that new course will be a herculean effort. But this country has made astounding efforts before. We can do it again.
Rt Hon Michael Gove
Chancellor of the Duchy of Lancaster