This year, CDS celebrates 10 years as an independent social enterprise. To mark this milestone, we are looking back in conversation with some of our colleagues who were part of those heady early days and who were instrumental in setting up the organisation we all know today. To begin the series, we are talking to Michael Cranfield, our Clinical Director, who was the driving force behind the decision to ‘spin out’ from the NHS and establish what is now ‘CDS CIC’ as a public service mutual.
What was motivating you to set up an independent social enterprise?
It’s important to understand the context of what had been happening in the years running up to this point. Historically, what was the community dental service had been part of various NHS community organisations, who had little understanding of or any particular interest in dentistry – it was never core business. I started with the Bedfordshire service after graduation from dental school becoming Clinical Director in 1990, and during that time the dental service had never really been a priority for the organisation. I remember very clearly sitting in clinical governance meetings where the main topic of discussion was about leg ulcers, which were obviously very important, but with no mention of oral health, and the importance of that to the local population whatsoever; there were standard service patient questionnaires, for example with no questions on dentistry. All this left us with the sense that we didn’t really “fit in” and would never be a priority.
I’d seen numerous changes to the service and although there were some welcome hard won opportunities to secure funding in ‘Personal Dental Service’ initiatives like that we obtained to set up the Dental Care Centre and develop our IT infrastructure, there was what seemed like a never ending cycle of constant re-organisations and frequent cuts to our dental budgets to fund other parts of the health service. We learnt to fight for the dental service, to seek out new opportunities, developing new services such as restorative care, which led to very good links with the Eastman Dental Hospital for example. This meant we were a very strong, close knit team, with an entrepreneurial tendency. Eventually, when faced with yet another cut to budget, an arbitrary reorganisation and proposed redundancies, we decided to explore the option of ‘Right to Request’ that had opened up through the 2010 health service reforms, and took a formal request to the then Regional Health Authority to leave the NHS and set up independently. This would allow us to control of our own destiny and make changes to the service that were in the best interests of our patients and our employees – that was the beginning of CDS CIC.
What did it feel like – what was going through your mind in those very early days transitioning out of your NHS organisation and setting up CDS?
It was exhilarating, scary, exhausting, and by no means a quick process. Our bid to the Regional Health Authority enabled us to receive some initial funding to help us develop the business case which had to go to the PCT Board. Some key people such as John Mabberly and Liz Watson worked alongside us to help with this. John played a key role in helping us to write the business plan and manage the politics with the PCT and subsequently became our first Chairman. Liz had previous experience supporting GP services set up as social enterprises and helped us with employee engagement and governance. The PCT added more conditions along the way, such as the need to put proposals to leave the NHS to a ballot to obtain agreement of 50% of the workforce. We consulted with the BDA to gain their confidence and this helped in gaining trust of the dental team, that this was in the best interests of dental services locally. Employees were involved at every step of the way in defining the governance model. Eventually when the ballot was held, over 70% of our workforce were in favour of setting up as a social enterprise. We all knew difficult times lay ahead, the initial budget being proposed required a 20% saving, but we knew we were going to be in charge of our own destiny and that is a feeling which has prevailed to this day. CDS was incorporated on 4th March and began trading on 1st April. Those were nervous times; we began trading before our formal contract with the PCT had been agreed and signed, and I remember a huge sense of relief when the contract was finally faxed over for us to sign. We were on our way!
Were employee ownership and social enterprise an important part of CDS’ business model?
Forming a Social Enterprise was a requirement of the ‘Right to Request’ and us deciding to be employee owned public service mutual was baked in from the start. It was right though; we definitely saw ourselves as a ‘family’. We explored a few governance models and eventually settled on being a social enterprise Community Interest Company as it defined a very strong social purpose that was important to us.
What were the biggest challenges you faced and what kept you awake at night?
Looking back, the biggest challenge was around the contract and getting that agreed. There was a lack of understanding on the part of the PCT about how a dental contract needed to be funded because it had traditionally been bundled up with other services. We had to present the finances to the PCT Board several times and there were issues around estate costs, and the costs of the redundancies we knew we had to make. We began working with David Hunt, who worked for the PCT at this stage, to get agreement on our budgets. We were also concerned about the ballot and whether colleagues would support setting up the new enterprise. We were conscious that employees were placing a lot of trust in us and that there was a possibility we could fail and that was a huge responsibility. We knew we needed to make cost savings through redundancies and this all added to the pressure of running what was effectively a start-up organisation and of course, continuing to provide high quality patient care. In the end we achieved this with only one non voluntary redundancy. We did bring in people to advise us, like David (who eventually joined us) and this helped a lot in the early days. I had some business experience as I’d had a spell as a GDP, and I had been seconded for a while to the post of business development manager for one Community Trust, which stood me in good stead – I was very proud to be the first shareholder member of our new organisation.
When you look back, what are you most proud of?
I’m proud that we were able to make it happen with all the barriers we had to overcome. I’m really proud that patient care has always been paramount, and we now have a service with very high levels of satisfaction – 98% of Patients giving a high satisfaction rating . We have consistently achieved a surplus and managed our finances well and have been very successful in gaining new business, so it is very exciting to be able to offer new specialist services to patients and also to have colleagues from other parts of the country join the team. I’m incredibly proud of what we have achieved in 10 years and how every member of the team (and I mean all employees not just those who work in the clinics – we are all ultimately part of a dental team) has risen to the challenge and made us so successful.
If you could have the last 10 years all over again what would you do differently?
I’d definitely say to gain a more thorough understanding of the finances before, during and after the transition to an independent organisation. I’d also try and make sure any colleagues who didn’t want to leave the organisation didn’t have to
Is there a single piece of advice you would give anyone setting up an organisation like CDS or that you wish someone had given you?
Essentially to hold your nerve and have courage and don’t be afraid to bring in new expertise and to ask for advice; there will inevitably be difficulties, but have faith in what you are doing even when you don’t have all the answers. It was also important to look after the team and recognise that there were challenges and that not everyone had wanted to join CDS – but the organisation needed to change – not changing wasn’t an option for us. It was important that we had the right leadership and a Chair that understood community dentistry and what CDS was trying to achieve; I was very pleased when Sue Gregory joined us as Chair, when John Mabberly stepped down, and again when Janet Clarke replaced Sue, and a little later, with Alison Reid as CEO we have really shone.
What do you hope the next the next 10 years will bring?
That we continue to thrive and be successful and sustainable and that we can achieve year-on-year continuous improvement in patient care with a contented, harmonious efficient and effective team
Would you do it all over again?
Yes, absolutely! CDS has been a success for patients, for the workforce and the Service.