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Dentistry mutuals proposal slammed

Minister insists more NHS employees are eager to ‘become their own bosses’ by running ‘mutuals’

A minister has insisted that more NHS employees are eager to ‘become their own bosses’ by running ‘mutuals’ – despite a stark warning that the policy ‘no legs’.

The ‘Big Society’ project – which the government is keen to expand into dentistry services – took a hammering in a report by a Commons select committee.

 The £10 million plans would quickly run out of steam without greater Whitehall support, the communities and local government committee found.

Much more effort must be put into providing advice and guidance to those wanting to set up a staff-led mutual if they were to ‘flourish’, its report said.

There should also be more coordinated leadership by the Cabinet Office and banks needed to be better educated on lending to mutuals and co-operatives.

The verdict appeared to back up the BDA’s prediction that dentists would tread cautiously before pressing to delivering care as mutuals – outside the NHS.

At least projects involving dentistry – in Sheffield, Torbay, Northamptonshire and North and North-East Essex – are among the first mutuals given the go-ahead.

However, in an interview with the House magazine for MPs and peers, Francis Maude, the Cabinet office minister, insisted the existing 100-odd schemes were ‘just the beginning’.

Shrugging off the criticism, Mr Maude said: “One of the things which, I think, is going to be a big feature of public service in years ahead is the growth of the public service mutual movement.

‘Groups of public servants spin themselves out of the public sector and set up, in most cases, on their own, but, in some cases, in a joint venture with the private sector or another organisation.’

Mr Maude said people he had met who set up mutuals were determined to ‘never go back’, because of the freedom it offered.

He added that they told him: ‘We don’t have to go through a process, don’t have to get clearance – we just have a contractual obligation to deliver and we need to work.’

Mr Maude argued that the ‘productivity improvements in mutuals are staggering’, adding: ‘A massive boost – it’s very exciting.’

Mutuals run their own budget, lease NHS equipment and the premises where they provide treatment and decide how to organise care without requiring the go-ahead from managers.

Staff will retain their health service pension and – at the start, at least – will probably be able to offer services without tendering and competing for a contract.

Pilot schemes have been offered grants of between £50,000 and £450,000, for start-up costs, staff costs, capital expenditure and business development. Alternatively, 25-year loans are available.

By Rob Merrick, parliamentary correspondent

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The government is desperate to hive off as many NHS services and other services that they can. Can't say I entirely blame them, as there are massive inefficiencies in the current system. Initial terms offered will be very tempting, but as the years roll by, the honeymoon with the government will end, and contracts will be change from being offered automatically to being tendered for competitively. Eventually those mutuals will find the going much tougher than when they started out.
Mutuals have in fact been around for some time. The 'right to request' introduced in 2006 saw the first pioneers in community health services set up independent provider organisations. Yes, there have been challenges, not least in dealing with procurement rules and workforce issues, but none of these are insurmountable. When I work with people who are choosing this route they cite 'headspace for innovation', freedom from crushing weight of bureaucracy, and being master of their own destiny (as opposed ot being taken over by a big corporate provider) as the main drivers. You can find out more about what is involved here: