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Focus on Independent Ambulance Provision The Coperforma Lesson: Below, Joe Sheehan, former MD of Medical Services Ltd (now part of Falck UK), discusses the importance of the psychological contract that should exist between employers and staff responsible for the delivery of Patient Transport Services, arguing that the Coperforma business model operated in Sussex, which failed so spectacularly earlier this year, could have been avoided if this vital element of service delivery was not omitted The recent news that NHS Commissioners in Sussex and Coperforma had agreed to discontinue with the patient transport contract has been unsurprising given the circumstances. Opinions differ about managed-servicesprovider contracts and the relative advantages or disadvantages over a directlyoperated service. Certainly, the top team at Coperforma, who I am sure honestly believed the new model of service was operable and genuinely aspired to deliver a quality patient transport service might have a different viewpoint to mine. As often happens to pioneers, once you have a first chance to fully test your new concept you are just as likely to end up going back to the drawing board and coming back later with something better. I am not arguing that all the component parts of the Coperforma managed-service offering are unworkable - but I certainly believe the strategy toward the staff delivering the service is structurally flawed, which is why I maintain that, without the patient-transport staff’s full support and emotional commitment, the contract would never have performed to the required level anyway. We are seeing a number of variances of this new type of organisational model (Uber, Deliveroo etc…) whereby technology appears to have the ability to move workers away from an obligated or responsible employer (either by degrees of separation or completely) to affect a risk and a liability transfer. Both Uber and Coperforma are using advanced algorithmic transport management software at the centre of their business model. But there is a choice here: patient-transport providers have the option of deploying this new technology and choosing to maintain a Winter 2016 | Ambulancetoday committed direct workforce as a matter of business strategy. On one level, the business strategy of Coperforma is that they would enjoy some of the profits for providing software and some contract-management to the service. Any subcontractors could also enjoy some of the profits, but do so by shouldering nearly all of the risk of employer obligations to staff as well as the significant vehicle investment liabilities and attendant contract running costs. At least one consequence of a servicedelivery-model which outsources workers and divorces the obligations and responsibilities of organisations for those workers is that you cannot really expect the same men and women to have shared ownership of the problem when the service runs into operational difficulties. In this case, the patient-transport staff who had been comfortably employed inside the NHS found themselves distanced by the Tupe transfer process and two tiers removed from their preferred NHS employment status. They did not transfer to Coperforma along with the award of the new contract, but were “doubleoutsourced” and parked with third-party subcontractors. The legal framework is I suppose, arguably correct but that’s not my point. My view is that the psychological contract between the provider of the patient transport service and the staff employed to deliver the service was clearly broken. I doubt Uber taxi drivers feel any (intrinsic) emotional reward on top of the cash fare (an extrinsic reward) the passenger pays. In sharp contrast to taxi drivers many patient transport staff choose the job because they see themselves as part of a socially valuable service and have an emotional commitment as well, which is expressed in the quality of patient care they provide. I have managed the process of ambulance staff transferring into the independent sector in the past. In all instances the transferring staff worked directly for the new service provider; and I am not sharing any secrets when I say that this was challenging. Some transferring staff needed to see genuine commitment from the new employer over a long period before the kind of relationships were built that support high-performing teams. It works in the other direction as well: a year or so ago in Shropshire, a number of patient transport staff transferred across on zero-hours contracts from the previous independent sector provider and were immediately offered permanent full-time employment contracts. Consequently, relationships, emotional commitment and better performance outcomes were built more quickly. When the TV news showed patient transport staff involved in industrial action, it was Coperforma and the CCG the staff were angry with, not the unheard- Biography: Joe Sheehan With back to back, build and sell successes, most notably as Managing Director of Medical Services Ltd, Joe Sheehan is a results-orientated strategic thinker and a motivated management professional with over thirty years’ experience in the transport management, logistics and healthcare transport industries. With a strong operational focus Joe built a successful career in express logistics and control centre management. He was part of the entrepreneurial team behind LDT PLC, which was acquired by Addison Lee in 2011. Subsequently, he developed and led Medical Services Ltd into the UK’s largest independent sector ambulance service, delivering over a million patient journeys a year for the NHS until sold to a global healthcare brand in 2014. Joe is currently undertaking an MBA at the the University of Kent and retains a strong interest in the development of UK and global ambulance delivery. Winter 2014 | Ambulancetoday3 45
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