NAViGO

In 2011, North East Lincolnshire mental health services ‘spun out’ of the public sector to become a social enterprise called NAViGO, commissioned by public budget holders to deliver NHS services. NAViGO specialise in care delivered in real-life settings – integrating care provision with daily life and through close working relationships with service users and their families and carers. The organisation has a tradition of involving service users, for instance in the governance of the organisation and recruitment processes, which helped drive the idea of establishing an independent provider or NHS services on a not-for-profit basis. 

NAViGO is now a Community Interest Company with both staff members and community members, who are both represented at Board level and with equal voting rights. The business initially started life with a multi-million pound three year contract from the NHS commissioners.

NAViGO provides NHS health and care services in North East Lincolnshire on behalf of the NHS, GPs and local authorities. The organisation delivers services for people with common mental health problems; in-patient, crisis and home support; community and acute mental health and memory service; services for people with dementia; support in the community and employment & training. It also delivers training and consultancy for other organisations working with mental health patients and those with employment and learning disabilities.

NAViGO Health and Social Care CIC has over 500 staff and delivers services for over 5,000 people. Its mission is to provide services that staff would be happy for their family to use and any surpluses are reinvested to develop and deliver more services. The organisation has a turnover of over £20 million. 

NAViGO has an employment and training scheme called Tukes which was established in July 2003 to provide opportunities to people with mental health problems and little or no previous training, qualifications or work experience. Tukes aims to support people to develop new skills, confidence and motivation, reconnecting them with the labour market. Tukes is about addressing the causes of mental health, preventing further problems, and not just the symptoms. Tukes runs cafés, catering services, cleaning services and conference facilities, laundry, property maintenance, horticultural services and a shop. Tukes cafés provide training, skills development and work experience in real working environments – this support people who are socially excluded due to mental health problems.

One of the key elements of NAViGO’s business model is how this Tukes service supports the viability of the rest of the business. In order to maintain facilities for example, rather than spend money on external service contractors, Tukes provides the service (such as fixing a shower, for instance) which in turn helps create training and employment opportunities for service users with mental health problems. This serves to improve the wellbeing of the population locally and reduces demands on the ‘core’ mental health services. The organisation delivers 3,000 hours training and work experience every month for people with mental health problems. 

One particularly innovative element of the NAViGO story is how the staff supported the transition to independence. Many spin-outs were nervous about asking staff and the community to vote, not least as some have seen this journey as part of the fracturing of the traditional NHS. But NAViGO polled staff, service users and carers and received overwhelming support for the idea - 75% of staff voted for the proposal and 98% of service users.

Other innovations include a project to turn housing into flats and then letting them to people in need.  Chris Payne, a Manager of the Community Mental Health Team (CMHT) was chosen as Innovation Champion at the Medipex 2013 NHS Innovation Awards for his pioneering health and wellbeing work with service users.

The organisation has been able to improve many aspects of its work since becoming an independent social enterprise. CEO Kevin Bond describes how the business has “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.” The culture of the organisation is increasingly about challenging traditional methods of doing things. The services in some areas have gone from neglected to award winning and a range of savings have been made since launch, cutting overheads by over £1 million and reducing absenteeism among staff.

NAViGO has now earned a renewal on its 3 year contract, built up reserves and been able to support the development of other social enterprises and attracted new grant funding. In the national NHS staff survey, staff survey results, NAViGO had 65% of all scores in the top category and staff hours missed through sickness has halved. NAViGO scored above the national average in all 15 service user experience questions and 67% of staff agreed that all staff involve service users in decisions about their care and treatment, 23% higher than the national average. 73% of staff would recommend NAViGO as an organisation to work for, 28% higher than others nationally.

On top of this, NAViGO won two Phillip Baxendale Awards in 2011, for Best Public Sector Employee-Led Mutual and the Employee Ownership Rising Star Award. It also won the 2011 Guardian Public Services Awards.

One challenge for NAViGO was assessing support for spinning out in such a large organisation. As Kevin Bond explains, if you are doing this in an organisation “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.” The spinning out process has been described as “hard and painful”. 

One risk to the organisation remains constant – that working with individuals with complex needs and mental health challenges poses significant risk to both the local population and reputational risk for an independent health provider. But above all, perhaps the greatest challenge for NAViGO is to provide “more for less”, managing significantly less resource in the face of greater demands from service users, seeing more people than ever before. Freedom from public sector rules has allowed the organisation the freedom to make changes which can save money but financial pressures will continue to impact on the business over the coming years.

Most recently, NAViGO have had to attend with rising rentsat the homes of Tukes. Services have had to be relocated from one building to other buildings across Grimsby. Kevin Bond explains that "The rent increase the landlord had required from us for future occupancy was not affordable or thought good value, in a climate where we are being funded less and less. After leasing this building for ten years, and improving the property and area surrounding it a great deal, we have found this very disappointing to leave, naturally.” As an independent social enterprise, NAViGO is arguably both more at risk and more in control of its own destiny than if it had it been operating from within the NHS estate.

Looking into the future, NAViGO’s leadership is aiming to become even more flexible, to reinvest more surplus every year, and to give members an even greater voice in the development of their services. In a tough economic climate, some services still need to be reformed and the business is looking increasingly at how it can work more closely with a more diverse range of partners including other parts of the NHS and more widely. 

The leadership of NAViGO does not necessarily aspire to manage a greater range of services in other parts of the country, Rather, they want to lead by example and show what is possible. 

As Kevin puts it “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.”

One lesson from the NAViGO experience is that people do often want to get involved more in the governance of their local NHS provider if they are given the opportunity to do so. For instance, over 200 people attended NAViGO’s first Annual General Meeting as an independent entity. The leadership also cites how to spin out successfully, you need a broad range of supporters around the emerging organisation and to work closely with and seek mutually constructive relationships with other social enterprises. 

Another lesson from the NAViGO experience and indeed from the woder family of ‘spin-outs’ from the NHS is that independence is not necessarily for every part of the public sector. There may be particular services, individual leaders or models of intervention which are particualry suited to the social enterprise ethos. Indeed, NAViGO was already socially entrepreneurial even before it was formally independent from the state.