Nursing the nation's cuts

Nursing the nation's cuts

Ann Rushforth is one of Scotland’s leading women entrepreneurs but after selling a slice of her business she's gone back to school to help her family’s firm blossom.

There are few professions where you see human life entering our harsh world. Being a qualified midwife allows a person to experience the intense pain and the unalloyed joy of childbirth.

Isn’t it amazing that at least two of Scotland’s leading women entrepreneurs have a nursing background – Ann Gloag, as a burns unit sister, and Ann Rushforth as a Royal College of Nursing-qualified midwife. Not really strange at all, says Ann Rushforth, who sees parallels with nursing and business. A good nurse needs to be efficient, disciplined and have the ability to communicate concisely: all vital attributes for business.

And there is also the ability to respond quickly to changing circumstances – especially with life-threatening consequences.

“You can’t go back and say, ‘We’ll leave that until tomorrow,’” says Rushforth.

“If there are things that require attention, they have to get done ‘today’. When you’re making decisions, you can’t put things aside and do it later. You have to make the best of the situation.” While Ann is proud of her achievements building ScotNursing into a successful UK company, she is defined by her experiences as a nurse and midwife, and although she still practices in case management and occupational health, she is pursuing a degree in occupational health at Robert Gordon University in Aberdeen.

“Although I’ve worked in this sector for 25 years, and a big part of it has been occupational health, I haven’t had the formal qualifications,” she explains about her part-time return to the classroom.

Today her office is in the large upstairs room in the rambling Victorian building at Crosslet House in Dumbarton, which is home to Halo Nurseries – owned and run by her daughter Mhairi – on the ground floor.

She can hear the shrieks of laughter from the children outside on the lawn, while directly below her office is the baby room where a seven-week old baby is the latest to be looked after by the child-minding staff.

In 1987, Ann started her own nursing and care company with the support of a government scheme and a £1,000 bank overdraft.

She set up the firm primarily because she couldn’t get the part-time midwifery work that would allow her to look after three young children.

“When I started the business I had a one-year-old, a two-year-old and a four-yearold,” she recalls.

“On occasions my youngest would play in the cardboard uniform box under the table.” ScotNursing Ltd and the associated companies was built up to a turnover of £16m and such was the return that Rushforth was able to wrest full control back from Aberdeen Murray Johnstone Private Equity, who had invested in the early days.

While ScotNursing remains the flagship brand, the company Health and Lifecare Options had two sides to the business – the care-at-home side and the nursing side for the provision of qualified nurses.

“I sold half of my business in March to Allied Healthcare for the long-term care at home,” she says.

“This is carers at home who provide domiciliary care. I wouldn’t want to separate a company again, it was a bit like separating Siamese twins. You don’t realise how interlocking everything is. There were IT systems, finances, files and even emails. It was difficult with the handover with some staff who had been with me for a long time.

It was making sure that all the things were happening properly.” She was helped in the £2.5m deal by Mary Campbell and the team from corporate advisory firm BLAS, whom Rushforth says was “fantastic”.

The sale of the care side came as the industry has had two clouds overhead in the last 12 months, not unrelated in some ways.

The collapse of the care homes operator Southern Cross, which was responsible for the day-to-day welfare of more than 30,000 elderly and infirm people, and the Government cut in funding to local councils, which has had a severe impact on social care budgets.

The fallout from Southern Cross has no direct bearing on Rushford’s firm – however, she has had care contracts with a number of local authorities who were affected.

“It’s difficult because most of the contracts we had were with local authorities and they were looking for savings,” she says. “They want the same for less. Initially, we were providing the care services at less cost than the councils’ in-house services. So, for them to be looking for 5% savings was difficult; it just can’t be done.

The only solution for us was selling it to a bigger company which gives the economies of scale.” Rushforth is diplomatic but concedes that there are difficulties when personal care is labour-intensive, requiring one-to-one contact time with each client and not always enough time or travel time allocated to the private sector contracts – plus many of the professional care workers earn little more than the minimum wage.

And while she anticipates further consolidation in the care home industry, she remains fully involved in the remaining half of the company. “We still provide qualified nurses at home for terminal and intensive care,” she explains. “Complex packages at home for people with things like tracheostomy and complex needs.

This is still nursing-led.” The company, which operates from Dumfries and Galloway to Shetland, has its own banks of nurses and doctors and can put together a number of packages for people with illnesses and disabilities, which allows them to stay at home.

This can be funded either privately, by employers, or by the health board, with insurance often covering for the terminally ill.

“Some insurance companies allow you to have private homecare by privately qualified nurses as part of the package nurses, doctors and all the professionals allied to medicine, and we cover the whole of Scotland from our head office in Dumbarton.

We still provide nurses to all the hospitals and prisons and nurses to courts across the country. For example, we’ve a nurse at Glasgow Sheriff Court all day on Monday – that’s one of the busiest courts in Europe.

If anyone has been in custody over the weekend and is unwell, then they will get help from our nurses.

“We are working on lots of occupational health contracts at the moment – what we are trying to do is give a very cost-effective service which gives companies what they need and delivers benefits to staff.

It’s a feelgood factor for staff knowing they are being looked after as well.” Better health in the workplace, which includes screening, means reduced sickness time and a much more productive workforce.

“If you pick up people in basic screening for high cholesterol and blood pressure, then this can made a difference in terms of strokes and heart attacks,” she says.

“It’s about changing lifestyle and getting the life balance.” Ultimately, it’s about keeping good staff! She is even looking at private doctors making house calls – something which has been disappearing as the NHS has moved toward its NHS24 model of patient care.

“It’s about giving people the choice of what they want to do – a bit like dental care,” she says.

“Why not? Some people might not want to sit in a minor injuries clinic for three hours and would rather pay to have someone come out and see them and check them over.” Isn’t there resistance to some of these private initiatives in healthcare? “When people talk about contacting out to the private sector, like nursing provision, some say they want to keep it in the public sector. But the public sector is an artificial market that has been created that isn’t as accountable because it’s managed by different tiers. If it’s our money, we just want it spent wisely.

“People might not be working for a council but a private provider still needs the people on the ground and you lose all the layer and layers of bureaucracy within different sectors.

I don’t have any problem with the private sector and the voluntary sector being used effectively working together to reduce costs, increase quality and choice. Why wouldn’t you?” So does Ann Rushforth get a lot of requests to pass on her knowledge to the NHS? “I’m in the private sector and I have been in the past invited to talk about healthcare in Scotland,” she says.

“I am interested in practising innovation. The one thing that frustrates me is that we don’t learn from other sectors and use what works.” She cites the airline booking and fee system which marries up times and prices based on availability and peaks and troughs in demand.

“I’ve been astonished by the amount of money spent on software in the health service that doesn’t actually work. It’s so frustrating, it’s not someone else’s money; it’s our money.

“British Airways and easyJet have a booking system that’s state-of-the-art and it strikes me that as long as you deal with all the confidentiality, why can’t you use similar systems so you can book appointments either by phone or online.” Rushforth agrees that individual health boards are doing this now and using texts to remind patients when an appointment is due. She also suggests a nominal fee that might be returned once people attend, which would discourage DNA (Did Not Attends).

“I still think the best managers within the health service are good managers who actually have a background in one of the medical professions. That’s because they understand the complexities. That’s not to say that there aren’t some good managers who don’t have that background – but I think it is better if you do have a medical or nursing understanding.” She says there is a massive paper chase, filling out documents, and while professionals must be accountable, there needs to be an element of trust and common sense.

“Yes, there should be an audit trail, but not at the detriment of care – and there is a middle-line to take on this,” she argues. Now that Rushforth has sold half of her business she is also devoting time to helping Mhairi, now 26, with the expansion of her childcare and nurseries business. Halo is already looking after more than 400 babies and toddlers and employs 50 staff, creating nearly £1m in turnover.

“In these difficult times it is more challenging and to be able to give her that support is great,” she says proudly. Mhairi, who was named outstanding student of the year at the Hunter Centre for Entrepreneurship when she graduated, obviously has plenty of her mother’s DNA.

They share the Rushforth sense of humour and when a Harry Potter ringtone goes off, Ann explains that her own mobile fell into the water on a boating trip and she’s borrowed Mhairi’s old one.

“I think I should get the ring change to a Casualty theme,” she says, “but I don’t know how to do it!” The nursery project involves the roll-out of a number of state-of-the-art nurseries in the West of Scotland.

When Ann Rushforth built ScotNursing she was able to move into a modern office building at Old Kirkpatrick.

After the sale in March, the building was far too big for them or Allied, so it has been sold to SubSea 7, the oil and gas service business, which was expanding in the North Sea.

“We’re looking to build something smaller for our company with a new nursery alongside,” she says. The lease runs out on Crosslet House in a few years and so the plans is to have a set of four, £1m custom-built nurseries in Helensburgh, Dumbarton, Bearsden and Milngavie.

“I am happy to help because it is not easy. Cash flow is always challenging. The banks are not able to work with companies the same way that they were in the past. That makes it more difficult.” Rushforth is also helping her son Stuart with his commercial landscaping business, but she concedes it is very hard for young people in Dunbartonshire finding work and making a living out of small business.

Ann was born in the Haldane council estate in Balloch, and lost her father, Andrew Mackay, when she was only 15.

Her first job was working in the labs of the British Silk dyeing factory on the Loch Lomond shores site, before going on to study nursing in Glasgow.

Her three brothers have all done well with engineering careers, while her sister is a geo-technical engineer.

“My mother and father were very clever,” she says. “He came down from the North and served his time as a pattern-maker. He worked in Yarrows and served his time with Denny’s shipyard in Dumbarton. My mum excelled in maths but had to leave school at 14 to contribute at home.” Ann sees part of her job as mentoring her own family.

She has been involved with Prince’s Youth Business Trust Accelerator Fund but with the sale of the business she has not had as much time to devote to this. She’s disappointed that more money is not being put into capital projects to stimulate the local economy. For example, she says the shelving of the Glasgow Airport rail link was not a wise move.

“I think it is short-sighted. Of course you need prudent budgeting but we need the public sector to develop the infrastructure, which can then help the private sector with new enterprises.” She was also a board member of Scottish Enterprise Dunbartonshire before it was shelved.

“I was privileged to work for the board for seven years – and I think we did a lot of important work and it was stimulating for the local economy,” she says. She is also a member of the Leading Women Entrepreneurs of the World. However, she says that the £100m Lomondgate – between Dumbarton and Alexandra on the A82, which had its foundation laid in September – is the kind of opportunity which is desperately needed.

“It’s in the West and the gateway to the Highlands. It is a fantastic site because of where it is and it’s also easily accessible to the airport. This is where we are going to have our new head office and our Dumbarton Halo nursery.”

The site is already the base of BBC’s River City, which has been given a reprieved by the corporation – all better news for West Dunbartonshire, says Ann.

She remains a staunch Labour party member and was encouraged to stand as a local councillor in West Dunbartonshire.

In 2007, she stood for the ward that she was born in on the shores of Loch Lomond, but she says, “Unfortunately, it was a marginal seat and there was a yellow tide of SNP and it was unlikely that I would win, but when I got to the count I actually wanted to be elected to make a difference.” She hasn’t ruled out standing for office once again, and was in the shortlist for the Westminster seat of John McFall in 2010.

She’s not afraid to stick up for what she sees as injustice and reckons Wendy Alexander, the former Scottish Labour leader, was given an unfairly rough ride by the media when she was cast aside over donations from the Channel Islands while she also expressed sympathy for Gordon Brown whom she says was pilloried because his personality didn’t come across in the media.

She was also an admirer of Tony Blair who came up to do a BBC Question Time from Stirling and showed real compassion and knowledge that often didn’t come across.

“There are a lot of politicians in it for the right reasons but when they all become tarnished with expenses scandals and the likes, it takes the focus away from what is really important,” she says.

“The problem I have is that we haven’t had the right Labour leader for a while. John Smith was the reason I joined the Labour Party; he was a man of great integrity.” While she is deeply serious in her concern for Scotland, her self-deprecating humour and her ability to have a hearty laugh is never far from the surface.

In 2007, when she went up to collect her MBE from the Prince of Wales at Buckingham Palace, she spotted Tom Hunter, then a fellow Entrepreneurial Exchange board member, preparing for his knighthood and they both had a laugh about their humble Scottish beginnings and their pathway to success.

“Tom’s dad was there, and my mum Annie,” she says with satisfaction. “We need more women to say they can do it. That’s why I’m happy to put myself forward; to show women who have children that it is possible to run a business – and enjoy their families.

Having a work-life balance that, while hectic, does give fulfilment in both personal and business life. Men take this all for granted – so why should we apologise for wanting both too?”