Case Study: City Health Care Partnership CIC

Employee ownership has been the sustaining force for City Health Care Partnership CIC (CHCP) sixteen years after it spun out of the NHS. But after more than a decade and a half, the issue wasn’t whether employee ownership still worked, but rather if anyone could still see it.

The rationale for becoming an employee owned spinout was framed as a way of protecting values, retaining talent, and delivering care differently outside of the constraints of NHS bureaucracy.

Given the business had been through the trial by fire of the Covid pandemic with its services intact, finances stable, and most of its workforce retained, it’s clear the decision was a sound one. It’s an especially impressive feat in a sector where vacancy rates and burnout have become endemic. Yet within the business, a growing sense emerged that employee ownership risked fading into the background and being taken for granted. 

The past two years have only sharpened that unease. Operational pressure hasn’t fully lifted in the way many had hoped for following the pandemic. Moreover, the wider healthcare system remains stretched and reactive. Within that churn, CHCP has begun asking itself a fundamental question of how an employee owned business (EOB) can ensure ownership still matters when everything else is demanding attention. 

This has resulted in re-embedding employee ownership and evolving the way it’s positioned to convey its benefits and better fit the business CHCP has become. 

Intentional Ownership

CHCP spun-out of the NHS in June 2010 with employee ownership providing the fundamental underpinning of its new identity as a community interest company (CIC). 

Throughout its subsequent growth, the business has remained proudly employee owned. But, more than fifteen years on, the workforce looks different. Many colleagues joined long after the spin-out and, for them, CHCP has seen growth – both contractually and geographically – which has seen even more colleagues join (often via TUPE transfers), presenting challenges in terms of awareness of CHCP’s ongoing employee ownership journey.

Concurrently, the business has undergone a maturation process. CHCP is a profitable, financially viable social enterprise with a widening geographic footprint. It generates surplus, maintains cash flow, and reinvests through a charitable arm focussed on community and workforce development. These outcomes align with findings from the EO Knowledge Programme that employee ownership improves retention, loyalty, and resilience whilst resulting in businesses that are 8-12% more productive.  

Despite the encouraging metrics seen within CHCP and noting the alignment to findings from the Knowledge Programme, it remains a challenge to illustrate the role employee ownership plays in the business’ successes because of its operating model and sector dynamics.

Post-Pandemic Fatigue

Although Covid didn’t break CHCP the way it did many other businesses, it did change the environment it operates in. During the height of the pandemic, healthcare providers were forced into survival mode with decisions becoming operational and reactive. As has been seen in other sectors, that mindset has been hard to shift.

It’s been doubly difficult as the pandemic compounded many pre-existing issues within the sector. Further frustrations continue with the ongoing shifts within the local and national systems CHCP operates in, often without clarity around what comes next.

But what differentiates CHCP’s experience is that, despite these conditions, colleague satisfaction and retention have remained high, particularly when compared with parts of the NHS. Internally, there’s confidence that employee ownership has played a material role in that stability. Externally, however, that story has been much harder to communicate. 

EO as a Stabilising Force

For much of its history, CHCP has embedded employee ownership through practice and leadership, rather than a specific strategy. Mechanisms for employee voice, engagement, and governance exist across the business and were deliberately established to strengthen connections between the workforce and boards and committees, even though they didn’t formally sit within an EO strategic framework.

Building on what’s come before, CHCP is now in the process of formalising a new employee ownership strategy, as part of a wider refresh to its strategic documents. Rather than redefining what EO means, the intention is to make its role clearer, focussing internally at first, then externally. 

This period also coincidences with a significant moment of transition at the top of the business. A new Chief Executive has been appointed alongside changes to the senior team, including a new Chair, and new non-executive directors. These appointments bring in different experiences and thinking from other settings at a time of significant change within the external environment.

Building Awareness from the Inside Out

External storytelling only works if internal understanding is solid. In practical terms, CHCP already has a well-developed internal communications infrastructure. A new intranet acts as a central platform while staff-wide emails, regular surveys, and an active Teams environment support day-to-day engagement. A weekly blog from the Chief Executive remains widely read and a key channel for disseminating information and nurturing engagement.

At the epicentre of this infrastructure sits ‘CHCP Social’, a cross-business committee bringing together operational and corporate colleagues. It functions as the main forum for EO activity and discussion and is routinely well attended. 

What’s changing is the emphasis placed on language and explanation. Employee ownership is being brought more clearly into CHCP’s onboarding process for new employees, whilst more fundamentally underpinning induction sessions. Moreover, the overarching storytelling around EO will form part of the strategic reset. 

Celebration has also played a key role, with employees always getting involved and engaging in annual EO Day celebrations. Elsewhere, surplus funds from the staff lottery scheme are channelled back into workforce-led activity including prize draws and shared experiences that help to make employee ownership more tangible. 

Learning From Outside the Business

One of the defining aspects of the employee owned community is its willingness to share insights, experiences, and best practice with others. CHCP is currently engaging with external partners as well as drawing on learning from across the EO landscape, especially on how more mature EOBs refresh their approach. 

Internally, the business has already undertaken a listening exercise to capture what EO means to colleagues and what they’d change given the chance. That material is now being used to inform the next phase of work, alongside input from external expertise. 

The intent is to move from implicit understanding to shared clarity without losing the flexibility that’s empowered the business to adapt in the past and build a resilience in a sector often beset by crisis.  

Entrepreneurial Savvy in the Face of Uncertainty

These changes are taking place against a backdrop of uncertainty. NHS commissioning is undergoing major changes, with restructuring, redundancies, and shifting priorities. 

The government’s ten-year plan for the NHS in England signals a move away from treatment towards preventative care, but the contractual mechanisms that will deliver that ambition remain unclear. 

CHCP is a well-established and important partner across the health and care system, but the business is mindful that the operational environment it currently sits in may look different in the years ahead. 

Change is inevitable, though its impact remains unknown, so rather than allowing this uncertainty to dictate strategy, CHCP is treating employee ownership as a point of orientation, whilst remaining pragmatic about what can be delivered in the here and now. 

The business defines itself as entrepreneurial by default, with an established curiosity about growth, diversification, and new delivery models. There remains interest in new opportunities as would befit any business with a truly entrepreneurial outlook, but always within clear boundaries. Those boundaries are rooted in CHCP’s key values of not extracting profit from health and social care, and reinvesting surplus into workforce and community. 

Making the Case, Carefully

CHCP are right to be curious about opportunities that may exist in the future yet equally right to remain pragmatic about the current environment. The business has experienced growth through previous periods of financial and contractual pressure and has come out stronger the other end. 

Employee ownership isn’t presented as a solution to every challenge, nor should it be positioned as such. But EO is increasingly seen as a lens through which the business can explain how it operates, why it retains its workforce, and how it delivers care differently. And CHCP isn’t alone in responding to challenges and change, with fellow EOBs and eoa members Spectrum Community Health CIC and Navigo in the healthcare sector. 

What remains frustrating is the limited attention employee ownership receives in policy and commissioning conversations nationally, despite the growing volume of evidence supporting it – including the ‘People Powered Care’ report from Care England and the eoa.

For CHCP, this only reinforces the importance of communication that’s grounded in metrics as much as values, demonstrating benefit in ways that resonate beyond the business itself. 

The Work Ahead

More than fifteen years after spinning out of the NHS, City Health Care Partnership CIC is evolving the ways in which its employee ownership and its myriad impacts are understood.

The next phase will involve months of strategic work, internal engagement, and narrative refinement. The overarching intention is to ensure employee ownership is embedded across the business.

In a sector marked by fatigue and uncertainty, CHPC is proving there’s a better way of delivering healthcare where everybody benefits. Why wouldn’t the rest of the healthcare sector want to operate on that same model?