Jane Miller: 'The community services sector is the bedrock'

Jane Miller is chief executive of Care Plus Group, a social enterprise delivering NHS community services as well as some adult social care services and primary care services in North East Lincolnshire. 

Can you tell us about Care Plus Group and what you do?

We're a spin out from the NHS and started as an organisation in 2011. We deliver NHS services and have done since we set out. We also deliver some adult social care services and primary care services, which is quite a wide-ranging collection of community services in North East Lincolnshire. We also have some additional services, such as a very successful employability service. 

Because we've got this whole combination, this whole basket of services, it enables us to provide some really high-quality wrap around holistic care for local people. 

We're not just health, we're so much more than that and we deliver everything the NHS does.

But we are different to NHS trusts in that we have to have a real financial discipline – we can't go into deficit at all. We have to have a balanced budget at year-end and that's something we really pride ourselves on. It's led to additional business interests that we've developed as part of that.

What makes you proud of working in the community sector?

In my humble opinion, the community services sector is the bedrock of health services across the UK. 

We are very close to local people. We're based in the community which enables our staff, who are out working with individuals who live in our communities, to know at first hand the challenges and strengths of those communities. 

Being based in the community, I think it's much easier than in the acute sector, for example, to be able to flex and innovate - particularly the kind of organisation that we are, a social enterprise. We're governed by the same rules, the same legislation that NHS trusts are – regulated by CQC – but we are able to be a bit more fleet of foot. We do tend to have a flatter structure, so perhaps a bit more speedier decision-making at times. 

All of that really enables and encourages staff to be more empowered to actually be able to make decisions when they're out there working in local communities on the ground. 

I think another key feature which is so important in the community sector, is strong partnership working across much wider than health and social care, particularly including the voluntary, community and social enterprise sector. But also through to wider services which have such an impact on the individuals that we work with - for example, housing. 

We have a particular service that works with the homeless community locally and it's absolutely essential that we work with those wider partners both locally but also in terms of national connections so that we can serve the people we work with in the best way possible.

Just to give you an example of a service that we have: we have a particular primary care centre, Open Door, which was an HSJ award winner in 2021. It’s quite a small centre comparative to many others, but we’re so proud that it was an award winner.

We have staff who must outreach because of the patient cohort, so they've had to be very creative and innovative in terms of what they do and the solutions they've come up with to deliver healthcare in that local community. 

For that particular surgery, we deliver the refugee and asylum seeker service locally. We work with local sex workers, we have the TB contract for the area and we work with the homeless population. 

But it's not just a case of providing healthcare because these are communities and we also have a lot of people who other GP providers won't accept on their list because of violence or other complications. So it wouldn't work if we're expecting people just to turn up for appointments. Our staff have to work on an outreach basis, out in communities, which actually is something they also enjoy doing, that very immediate contact with the patient cohort.

For somebody who's experiencing homelessness, they’ll work with them, support them to get into work working with a local JobCentre Plus and Department for Work and Pensions. That might mean even accompanying them to interviews, providing them with clothes to get there so they're ready and able to take part in that interview as best they can. 

It’s a really innovative approach and I'm so proud of what our staff do and that they are able to work in that way.

Why do you think it's important that we empower community services?

I think it brings so much added value to have staff working in a way that is innovative. They are able to take decisions in the role they undertake and that just brings the added value.

I think what we are able to also bring about within the community setting is such strong partnership working. That is something that, to a certain extent, we take for granted because we've been doing it for so long. 

Where I work in North East Lincolnshire, we have a very extensive history of place-based working and we've really been able to realise the premium of working at place and the  added value of integration. People are were working collectively together and developing things like integrated neighbourhood teams. That brings more added value. I think that can only happen in communities. It doesn't tend to happen in the same way in building-based delivery. I think that's an enormous strength. 

More than anything our staff are just able to identify, respond and actually feed into further developments and planning around what the real issues of our local communities are. 

One of the things we did, for example, was as an organisation to develop a charitable arm; we devote some of our own funds into that each year. Staff will do sponsored walks and things like that. 

How we use that collective pot of money is we give out grants to the local community. They have been far ranging – from using money to have something done in somebody's home, to actually get them out of hospital. It’s a really good use of money for the system, for the wider health system, but also to support some local community groups who are in turn supporting vulnerable people in the community.

That's been a really valued thing that we've been able to do locally for not a lot of investment from us. 

One of the other things that I often hear a lot in the NHS now is about anchor organisations. Community organisations have been acting as anchor organisations for some time now and really trying to influence and improve population health locally. That's something we continue to do as well and it does inform decisions we make.

How do you think that community providers can be enabled to go further faster to support the government’s ambitions to shift to a more preventative, community-based model of care?

I suppose two main things really. I've already talked about partnership, but I think it is this premium of place. 

Again, I talked earlier about added value, I think the more we do that, the more it's a win- win for everybody, and certainly for local people who constantly tell us they're not bothered who delivers services. They just want good quality services: the right service, the right place, the right time. 

The other major thing is to finally move services out of hospital that are appropriate to do so. 

We've talked about this for a long time and we still have an awful lot of services provided in hospital, dragging people up to hospital and going into A&E. 

We know if people go to A&E they’re more likely to end up as an inpatient in the hospital. If we can move services out, with appropriate funding to make that possible, then it's closer to people who use them and it's good value for money. It makes sense for everybody. 

What is the one key ask you have of the new government? 

The acute sector provides an invaluable and usually high-quality service nationally. It is  an absolutely vital leading part of the delivery of health services, but it does tend to dominate discussions and the agenda. It’s about trying to move community services onto more of a level playing field with the debate about acute services.

The other thing I'd say is a specific social enterprises request: treat social enterprises who are delivering NHS contracts in the same way as the NHS.

For example, we can't access NHS capital, digital funding or training funding for our staff in the same way as NHS trusts can. So that's my plea: to make it a level playing field.