More than 10,000 community nurses have been transferred from the NHS to social enterprise schemes under a major government programme, an investigation by Nursing Times can reveal.
Unions have raised concerns the move will create a “two-tier workforce” and warned that social enterprises are vulnerable to privatisation. Meanwhile, social enterprise supporters say the model can provide better services for patients and means less bureaucracy for nurses.
The investigation provides the first comprehensive snapshot of what has happened to the community nursing workforce under the “transforming community services” programme, which has been underway since 2009 and officially ended in March this year.
The programme required every primary care trust in England to separate itself from its community services section. As a result, community services have mostly been transferred to other types of local NHS service provider or established themselves as social enterprise schemes, independent of the health service.
Nursing Times has obtained information on 21 of the 25 social enterprises known to be involved in the transfer. It reveals that 9,134 former NHS nurses or nursing support staff now work for them, or are in the final process of transfer to them (see map opposite).
Some of Surrey’s 3,000 community staff, including nurses, have also transferred to two social enterprises – pushing the likely national total easily beyond 10,000.
This Surrey group includes nurses already working for Central Surrey Health – the first, and most successful, social enterprise. Neither Central Surrey Health nor new East Surrey social enterprise First Community Health and Care would provide Nursing Times with workforce details.
Likewise Bromley Healthcare Community Interest Company would not reveal workforce numbers.
The remainder of NHS Surrey’s community staff are, however, set to move a further step away from the NHS. The PCT is in the final stages of agreeing a contract that will see them move to private provider Assura Medical Limited by December. Assura is also one of the organisations bidding to take on 709 community nurses in Suffolk.
Social enterprises are private bodies but must guarantee their assets are used for the benefit of the community. Transferred NHS staff keep their Agenda for Change terms and conditions and remain in the NHS pension scheme under Transfer of Undertakings (Protection of Employment) (TUPE) laws.
For new staff recruited after the transfer, half of the social enterprises contacted by Nursing Times said they would offer NHS “equivalent” terms and conditions. But only one said it was able to offer the NHS pension scheme to new staff.
Your Healthcare in Kingston had the right to offer the NHS pension scheme to new staff written into its contract. The Department of Health has since ruled out this arrangement for other social enterprises.
Unite professional officer for health David Munday warned that most staff joining social enterprises in future would have unfavourable terms and pensions, creating a “two tier workforce”. He said: “It is extremely destabilising, very poor for moral and actually very unfair.”
He also warned that even those staff transferred on existing terms and conditions could be worse off in future, as there was no guarantee social enterprises would pass on national pay deals negotiated in future.
However, clinical nurse specialist Mary Warrilow told Nursing Times the move to a social enterprise could be positive for nurses.
Lymphoedema services in Dudley will this week transfer to Lymphcare UK, along with five nursing staff including Ms Warrilow. “We still feel quite involved in the NHS. We can be more flexible [as] we’re not so large. Decisions can be made quickly and there is less bureaucracy,” she said.
Sirona Health and Care, a social enterprise in Bath and North East Somerset, has taken on both NHS and local authority staff. Chief Executive Janet Rowse admitted some of its new staff had not been in favour of the move, but she said: “It is about the model that delivers the best results for service users.”
Ms Rowse said the social enterprise was likely to pass on nationally agreed changes to terms and conditions as it had “to be in a position to recruit and retain staff”.