You get what you pay for
19 February 2025
Ahead of next week’s GGI webinar on sustainable funding and partnerships, we share an inspiring turnaround tale from East London
At next week’s GGI webinar Partnerships and funding for sustainability and performance, one of our guest speakers will be Steve Rubery, CEO of Partnership of East London Co-operatives (PELC), a provider of urgent treatment centres and out-of-hours GP home visiting services.
Steve has overseen a remarkable turnaround at PELC, which faced an existential crisis in 2022 that he says was partly due to an unrealistic funding model.
Steve says, “I would say that there has been a race to the bottom on the purchaser/provider split, with commissioners pushing to spend less and get more and providers trying to charge more and do less. But if that’s pushed too far, you end up with nothing.”
Rude awakening
PELC’s rude awakening came in 2022 when a CQC inspection rated all four of PELC’s urgent treatment centres as inadequate, with numerous issues across multiple areas, including initial assessment times, staffing and process gaps, inaccurate clinical assessment data, complaints backlogs and clinical shortcomings.
Steve and his colleagues put together a comprehensive action plan to address the breaches and shortcomings, changing the organisation’s structures, governance, processes and values, and improving communication, learning and stakeholder engagement.
From January 2023, the picture started to improve, with steady gains in initial assessment and four-hour performance in all four centres. Risk management, patient experience and complaint handling also improved.
But they also recognised that there was an issue underlying PELC’s four-hour performance that went beyond the operational problems—and it had to be addressed urgently to secure their longer-term survival.
Steve says, “We realised that some of the required improvements would be impossible under the existing funding model, which we felt had been set up incorrectly in the first place. We got to the stage where we were losing around £100k a month but still delivering a poor service. We looked carefully and concluded that we couldn’t deliver the required service for the money—we faced winding up the company if something didn’t change quickly.
“So, I met the CEO of the ICB and set out the problem. I said they were paying an unrealistic amount of money for the service and that we needed to have a sensible conversation about it. And that’s exactly what we did.”
Road to recovery
That conversation led to a new cost-based contract, featuring a fully transparent open-book exercise every year to prove the money was being spent properly.
The result was a huge improvement in the CQC follow-up inspection that took place in June 2023, with the lead inspector remarking that he’d never seen such a significant improvement over such a short period before.
Looking back on the experience, Steve has two clear messages. He says, “I would say to providers: if the money doesn’t add up, don’t bid for the services. We need to stand shoulder to shoulder and say, ‘we’re not bidding for this because there’s not enough money to do it properly’.
“And to commissioners, I would say this: be realistic about the art of the possible. You can have high-quality services for less than national tariff costs, but you need to be realistic about how low you can go.”
Join us on Wednesday, 26 February, 08.30-09.30, when Steve will share more details about PELC’s journey. Our other guest speaker will be Rachel Peacock, chief executive of Making Space, a national mental health and social care provider, who has experienced many different funding and partnership approaches, ranging from the very transactional through to much more joined-up and strategic arrangements.
