Tom Fleming speaks to the woman leading the latest new business in Birmingham’s healthcare sector.
Vicki Fitzgerald is a little apprehensive about the spending cuts George Osborne is planning for what he regards as the UK’s bloated public sector.
The Chancellor’s remedy for institutional obesity is almost certain to involve some unpleasant medicine, as well as substantial surgery, and she fears that businesses like hers, which was spun out of the NHS four years ago, could become accidental casualties.
As chief executive of Gateway Family Services she is waiting to see where the lancet draws first blood, and whether the local authorities and Primary Care Trusts that constitute her customers will have significantly less to spend.
Healthcare is big business in Britain today, and there are no signs that it will suffer any shrinkage in the long term. But for the present?
“There are some difficult times ahead,” she admits. “I’m aware that the public sector squeeze will affect us in some way, but we can’t let it divert us from our aim of recruiting local people and training them to do local jobs.”
There’s no escaping the strong social aspect to Gateway’s work. It is one of the five “flagship” organisations selected by Social Enterprise West Midlands as beacons of excellence – demonstrating the benefits that flow from applying rigorous business discipline to social enterprises.
Gateway’s stated aim is to tackle health and employment inequality in all its guises – from work opportunities to accessing health services – by recruiting and training people who are often cash poor, but rich in experience and practical knowledge.
That said, it operates just like any other competitive business with an eye to winning and keeping clients through the delivery of first rate services.
True, it’s an unusual business model - for example recruits are not required to have any formal qualifications in order to be accepted onto its range of training courses.
In fact at one stage about 85 per cent of candidates had a reading age below 14. No problem, says Fitzgerald. That is a situation that can be – and is – addressed very successfully, with people routinely graduating from training courses having achieved distinctions in their literacy tests.
Some enjoy the learning process so much that they go on to achieve respectable degrees, no matter how poor an early education they may have had.
While undergoing training, candidates are placed in apprenticeships around the West Midlands, and become hugely enthused when the door of opportunity swings open.
“A lot of people, when they get a job, are really ‘up and at ‘em’ and it can be frustrating for them if they don’t have the literacy skills to progress,” says Fitzgerald. “Improving their literacy is just one of the many things we do which boosts their confidence.”
The direction in which Gateway has developed, in the short time since it first plunged into the third sector and embraced the business ethos, is also remarkable.
Unbundling the business from the NHS had several obvious benefits. Firstly it did away with any geographic obstacles to growth, by removing the primary care trust boundaries that had restricted its operations.
Secondly it opened up sources of funding that were inaccessible to any branch of the NHS, and finally it gave the fledgling business greater flexibility.
“When we were spun out of the health service in 2006, the intention was that we would become a training agency,” Kidderminster-born Fitzgerald confides. “We wanted to equip people with the skills and the confidence to get work.
“But what we discovered was that to make it all operate in the way we intended, we had to become involved in the running of the services.”
Fitzgerald developed her business ethos while employed as an NHS outreach worker in the South Aston and Newtown areas of Birmingham, a decade or so ago.
“I learned an awful lot there,” she says. “I recognised the enormous benefits of recruiting local people who understood the people they were trying to help.
“I set up a scheme to train some mums, and they then volunteered to support other mums in the area, particularly on the issue of breast feeding. I found them to be knowledgeable, experienced, and also really willing to help.
“That is a common perception about inner city residents – that they are takers, not givers. But I found exactly the opposite. They were more than happy to help their neighbours in any way they could.”
Having struck social gold with her volunteers, Fitzgerald then set about devising training courses that would lead to some form of accreditation – portable proof that they had achieved measurable standards.
News spread and before long the primary care trust she was working for wanted her to help train parents as part of the Labour government’s Sure Start Children’s Centre initiative.
The idea was to put workers into ‘hard to reach’ communities, spreading the word about the vital importance of medical checks for babies, and issues like immunisation programmes. It worked.
“Because they knew so much more than anyone else about what made their neighbours tick, and had endured similar experiences, they were much more able to change their behaviour.”
Fitzgerald’s argument is that – easy target though it may be – cutting back on the services Gateway provides would be a false economy, and that pennies spent with her now, can save pounds down the line.
In pure business terms, Gateway is a pretty typical SME – 180 employees, 40 per cent of whom were unemployed when they started) and an annual turnover of £3.4 million, put it shoulder to shoulder with hundreds, if not thousands, of other West Midlands operations.
“We have trained more than 800 people in the past four years and they have gone on to find employment in all sorts of sectors,” she said.
“What’s more, in terms of changing people’s lifestyles – to quit smoking, lose weight and improve their income and housing – we have helped 5,000 people over the same period.
“And just like any other business we are audited, pay corporation tax and VAT and of course we have a board of directors.”
Just like any other business too, Gateway has expansion plans. It already has contracts with seven Primary Care Trusts in the West Midlands, and is targeting others, along with local authorities.
To date it has no ambitions to physically expand into other regions, but might consider franchising its model if interest were shown from around the country.
Fitzgerald believes that despite the years that have passed since she first joined the NHS – she turned her back on the world of advertising and marketing when she returned to work after a ten year break raising three sons – the important challenges remain depressingly familiar.
Ever-present issues like obesity, smoking and mental health are the hallmarks of inequality, acting as shackles on social mobility, she argues, firmly connected to one another like links on a chain.
“Largely, one inequality leads to another,” she says. “In most cases, if you are poor in income you are also poor in terms of health, employment, and education. It’s very rare to find people who are poor in one area, but flourishing in others.”
“There is still a big job to do,” she confesses. “Smoking and obesity still have to be tackled, and health inequality has widened. The middle classes are getting healthier, the poor remain the same.
“And Birmingham has the worst infant mortality rate in Europe, with 12 deaths per thousand births. That’s a terrible statistic.”