Ambulance

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.
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