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Sirona

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Sirona is a not-for-profit company or community interest company (CIC), based in the Bristol area. The company has a large number of contracts providing community health and social care in and around the Bristol, Bath, Somerset and Gloucestershire area. In 2019, it was awarded a large ten year contract worth £1.06 billion for the provision of community health services in the Bristol, North East Somerset and South Gloucestershire area.  

 

Strategy

Sirona Care & Health is a community interest company that was set up in October 2011 by the then Primary Care Trust and local councils to provide health and social care services.  The company provides services in the community and in people's homes from short-term support to long-term conditions.

The company has been very successful at winning contracts in and around the Bristol region and following the award of a ten year contract to provide adult community services across Bristol, North Somerset and South Gloucestershire, it is the dominant provider of these services. According to the company's annual return its board has a strategic plan which "includes targeted growth through tendered contracts and increased provision of services meeting local demands."

Not all contracts have gone to plan, in 2019 Sirona reported that it had "reached a mutual agreement with Bath and North East Somerset Council to transfer back the residential and extra care homes to the council" by October 2020. (see concerns).

Financials

For the year ending 31 March 2020, Sirona reported income of almost £76.4 million, up from £72.2 million in 2019. The company reported a deficit after tax of almost £1.7 million, down from a surplus in 2019 of £48,000.

Contracts

In September 2019, Sirona won a ten year contract worth £1.06 billion, which began at the start of April 2020, for adult community healthcare services in Bristol, North Somerset and South Gloucestershire. The lead commissioners were the local CCG, but the local councils were also involved as the contract covers some public health services and social care.

With the award of the Bristol area contract, Sirona became the dominant health and care company in the Bristol, North Somerset and South Gloucestershire area for community services, both adult and children. Sirona beat two rival CICs to the contract, Bristol Community Health CIC and North Somerset Community Partnership CIC. As a result of the award, both Bristol Community Health CIC and North Somerset Community Partnership have ceased trading.

Under the £1.06 billion contract, Sirona is a prime provider, which allows the company to sub-contract services to other organisations. Sirona had already provided adult community services in South Gloucestershire under a previous contract. Sirona has sub-contracted CAMHS to Avon & Wiltshire Mental Health Partnership NHS Trust (AWP), in Bristol and South Gloucestershire for a number of years and from April 2020 will sub-contract CAMHS in North Somerset to AWP. 

Sirona has also gradually taken over children’s community health services in the area. Under a contract from 2017, Sirona runs children’s services across Bristol and South Gloucestershire as the lead in a partnership that included Bristol Community Health CIC (now ceased trading), Avon and Wiltshire Mental Health Partnership Trust and University Hospitals Bristol FT. The five year contract is worth £34.6m a year, and covers health visiting, school nursing, child and adolescent mental health, community paediatricians, and community nursing until 2022. 

Then in January 2020, Sirona took over the contract for specialist children’s community health services in North Somerset. These services include community paediatrics, physiotherapy and speech and language therapy; as well as Child and Adolescent Mental Health Services (CAMHS). These services had all been run by Weston Area Health NHS Trust, but it decided to withdraw from the contract. This was reported by Bristol, North Somerset and South Gloucestershire (BNSSG) CCG as a transfer and no competitive tender process took place.

Sirona did have a contract with the local council to provide residential and extra care services in Bath, Keynsham and Midsomer Norton area, however the company gave 12 month notice of leaving the contract in September 2019. Sirona noted that "The decision was taken because the on-going provision is financially unsustainable for Sirona as a not-for-profit social enterprise."

 

Concerns

Community Interest Companies (CIC), with their promises of reinvestment of profit and strong community-base, are often viewed as somehow having a more benign influence on the NHS than private companies, such as Virgin or Care UK, which are always seeking profit for their shareholders.

Yet Sirona in the last few years has exhibited behaviour that private companies have been criticised for in the past -  Sirona has both asked for more money for contracts and walked away due to a contract being financially unviable. Virgin has been heavily criticised for actions such as these in the past.

In April 2019, the local CCG accused Sirona of “burying its head in the sand” over failures to assess vulnerable children across Bristol and South Gloucestershire. Sirona ran the contract to provide initial health assessments (IHAs) and review health assessments (RHAs) after a child has been in the area 12 months from 2017-2022.

Under the contract, the company was supposed to provide initial health checks for 90% of looked-after youngsters within 28 days of them moving into the area but it achieved just 7% — nine out of 123 kids — in the city over the last 12 months, according to its own figures. And in South Gloucestershire, the figure was just with 24% - 12 children out of the 50 who came under the local authority’s care in 2018/19 - assessed on arrival.

Sirona insisted that it needed more money as funding had been reduced and requested £155,000 for three extra specialist nurses. The Bristol Post, however, reported that the CCG dismissed the request after launching a “forensic review” of the service which confirmed that funding had not reduced and there had actually been a 4% drop in the number of children in care moving to Bristol and South Gloucestershire.

Sirona walked away from a contract that it said was not financially viable in 2019. In September 2019, Sirona gave notice on a contract for three Community Resource Centres (residential services) and five Extra Care services in Bath and North East Somerset. These have now been taken over by the council. Sirona claimed that the on-going provision was financially unsustainable. The company had been in dispute with its staff since 2018 over pay and conditions and there had been intermittent 24 hour strikes. In an effort to save money, Sirona had asked staff to move from paid to unpaid breaks when they work more than six hours.

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