WE are all aware that the finances of the NHS are in crisis. To combat this the Coalition Government is continuing an initiative suggested by the last administration with all party support to re-organise certain aspects of the Health Service. To this end NHS Gloucester held a meeting last Saturday in Coleford on 'Transforming Community Services'. The purpose was to allow certain invited people (not the public) to share their views on the future management of community health services.

The upshot is that a Social Enterprise Community Interest Company (CIC) is to be set up countywide to provide 'high quality services in ways that are flexible, non-bureaucratic and have the potential to deliver good value for money.' In the Forest, with our recent experience of a CIC, this possibility immediately sets alarm bells ringing and to some is a red rag to a bull. (The Forest of Dean Health and Social Care CIC is currently still under investigation by auditors).

Although the (small) audience on Saturday was told that there are options in changing the current situation within the Health Service it was very quickly apparent that the choice has already been made and that the purpose of this meeting was information, not consultation. 'Sharing views' was merely a convenient phrase, as any views expressed are very unlikely to be taken into consideration. A business plan has already been formulated and will be submitted to the Strategic Health Authority, the decision-makers, before Christmas, with implementation of the new organisation by April 1 next. Not surprisingly there was much scepticism among the people present. 

The team explaining the background on Saturday admitted that there are risks to a Community Interest Company, as it has, with no track record, questionable expertise in its management and no staff at its inception, to compete to deliver services with existing commercial companies. Additionally, it will be subject to VAT, as current NHS service providers are not. This ensures that 20 per cent of any money spent on health service provision by a CIC returns straight to the government. For NHS accountants there will appear to be a saving in funding, as the CIC costs will not appear in the NHS budget.

One of the risks already identified by the team is the cost of establishing a stand-alone organisation. Around £250,000 of public money was wasted on setting up the Forest CIC that was immediately moribund, so what will be the cost county-wide? The company is envisaged to be limited by share-holdings, but the only people allowed to hold shares will be the staff, not the public, so where is the community involvement and potential for accountability? As these last two concepts are being sold to the public as the supposed reasons for change, along with better value for money which is debatable, it appears that this is window-dressing only. One member of the public commented, 'there are vested interests here and the whole thing smells.' Furthermore, the team admitted that the possibility of failure of any CIC in years to come has to be faced. What will be the future then for the services it is delivering?

It is envisaged that scrutiny of any new CIC will be by the local council, presumably Gloucestershire County Council. The Scrutiny team of Forest of Dean District Council was supposed to be scrutinising the Forest CIC, with little effect, so we cannot place much confidence in this possibility. This entire project bristles with difficulties and is unlikely to be well received by the public if Saturday's meeting is a barometer. We were assured that no decisions have yet been made, an assertion quite obviously untrue. Although experience indicates that rushed decisions are bad decisions it is apparent that it has already been decided to form a CIC, with implementation within six months, so it is difficult to know what can be done. Even the NHS team, although presenting a brave face to the audience, admitted they are carrying out instructions from above and did not appear entirely committed to the project. We were further informed that the Government wishes the UK to have more Social Enterprises and CICs than anywhere else in Europe. What on earth for? Is this some kind of mad competition by governments that we know nothing about?

Most of my generation owe their continued longevity to the NHS so the meeting on Saturday was not only frustrating , it was, in its implications, frightening.

– Dr Daphne Pearson, Redbrook.