For your social enterprise to thrive, diversify
Justine Gibling and Sarah Edwards of social care social enterprise Ripplez advise diversifying when you're faced with commissioning changes.
What do you do when the terms of your contracts change, commissioners want the same services from you but offer smaller budgets and your major funder ceases investment?
This complex business challenge was faced by Ripplez. Business development director Sarah Edwards and CEO Justine Gibling shared their experience at a recent meeting of the social enterprise leaders club E3M, held at the offices of lawyers Bates Wells Braithwaite.
Ripplez span out of Derby NHS primary care trust in 2011, starting with 11 members of staff. With it went a five year contract worth £750,000. The social enterprise started with one offering: the Family Nurse Partnership (FNP).
FNP is an evidence based service that was trialled and found to be highly effective in improving outcomes for teenage mums and their children in the USA. The family nurse replaces the health visitor assigned to pregnant teenagers. The difference is that a nurse visits weekly or fortnightly until the child is two years old.
Family nurses work to the fidelity of the programme in a strengths based way covering personal health, housing, education, the new role as a parent and relationships. The aim is to help young mothers and their children have better outcomes in life.
Thing went well initially: the Cabinet Office was supportive and Impetus PEF invested to help scale up the organisation, seeing opportunities for the initiative to expand to other areas. It did so, expanding into the wider Derbyshire county and east Staffordshire. In 2015-2016 Ripplez employed 50 staff.
But then, the commissioning landscape changed. In 2016 contracts with NHS England were passed to local authorities.
In addition, as the contracts that Ripplez had came up for renewal they became part of larger packages of public health services worth £7m. Ripplez were too small an organisation to service these larger packages.
Any contracts serviceable by Ripplez were offered with significantly reduced budgets. Edwards and Gibling were confronted with a situation where they were being asked to offer services for 10% less.
At the E3M gathering, business development director Edwards related their response was to say that they could work to the new budget, but wouldn’t be able to deliver the same level of service to the same number of people.
The effectiveness of FNP was then scrutinised via a random control trial and although it was recognised to have delivered excellent result in some area it was not found to evidence the same impact as in America on a number of key public health outcomes such as reduced smoking and increased breastfeeding levels. Unlike the UK, the US has no universal health visiting in the US.
As a result some commissioners decided to decommission FNP. At the same time, investment from Impetus PEF came to an end. It was, as CEO Justine Gibling describes it “a perfect storm.”
The way out of trouble
One advantage Ripplez did have was positive relationships with commissioners. Gibling had worked in that role herself previously, so had empathy. “We had to tell them, in a language they could understand, how they could meet their priorities,” she said.
The answer was to offer a greater choice of services but a significant obstacle was staff wedded to the one product Ripplez offered. “Some coercive encouragement was needed,” says Gibling. “We needed to restructure. We had come from a time of plenty and actually we needed to return to why we existed.”
Ripplez had identified their mission earlier: to make a positive difference to the lives of families so that they can achieve their highest potential and benefit future generations. Gibling says pointing to that mission helped to re-engage staff.
She also understood that there would be some who wouldn’t want to change their minds: “We were prepared to let them go if this wasn’t right for them.”
Culture change is always difficult Gibling says, but the key is to be clear about the reason you do the work. “We’re not in it for the money. We’re in it for the people we support. When you’ve got that at the heart of who you are, you make the right decisions because it’s for the right reasons.” H
er advice is to be clear with communications to staff and consistent with the message. “We were as truthful and transparent as we possibly could be, from board level to team meetings.”
Staff were told that the organisation could carry on only delivering FNP “but that would only last for 12 months and then we won’t be doing anything. Or we can hold on to the core element of what you really believe in and work around it,” as Gibling put it.
A happy ending?
Ripplez came up with new offerings and went back to commissioners, telling them they had services for targeted groups that needed support.
There are now five services altogether, including programmes aimed at women in a destructive cycle of multiple births resulting in those children being taken into care and a home delivery programme for those not able to access the FNP visiting service.
It also meant difficult decisions. Gibling shared that the organisation will not be re-bidding for a contract they currently service as it has become loss making since the commissioner sought the same service with a reduced budget.
Ripplez is now experiencing “steady growth” according to Gibling and with a wider spectrum of services to offer, look well placed to prosper going forward.
For more on the E3M social enterprise leaders network, click here.
Photo credit: Ethan Sykes/Unsplash