Social Enterprises and the NHS - Unison

I don’t think it’s the case of their being sort of dragged
unwilling into the NHS; it’s really that they’ve been trying
to make the links and win contracts for quite a long
time, and it’s never really been given much priority at
any level (NVO representative).
Some saw the forte of social enterprises as straddling
the divide between health and social care, an area in
which social enterprises were described as having a
great deal of experience; others saw their particular
contribution as forging strong relationships with their
clients and occupying small niches - the latter being of
less interest to the private sector. It was also argued
that their specificity could lead to a much better
relationship with diverse communities.
But I think anything where people need a personalised
service that’s close to them and focuses on their needs,
rather than just needing a procedure, like an operation,
would be a natural fit for a lot of social enterprises (NVO
representative).
Of particular interest was the development of social
enterprises in under-doctored areas, especially where
services were being developed jointly across primary
and social care or for specific health improvement
services.
One interviewee considered that social enterprises
offered the greatest potential in services which had
suffered a historical lack of investment, such as support
and day care services, and care in people’s homes for
people with long-term conditions as there were
‘greater opportunities for governance and a much
greater opportunity for ownership on the part of the
user’ (Professional representative).
While there was broad agreement over the role of social
enterprises in niche markets, or in identifying and
responding to gaps in mainstream provision, drivers for
the expansion of social enterprises into areas of
mainstream healthcare provision raised different and
polarised views in relation to three main areas: (1) the
impact of contestability and of a market model; (2)
degree of ownership of the organisation; and (3)
whether social enterprises would encourage innovation
in public services. These are discussed in turn.
5.3.1 A lust for plurality?
A major policy driver was the commitment of New
Labour to create a competitive market and a range of
new providers with the aim of improving the
performance of the NHS. For interviewees who
supported a decline in the role of the state in providing
services, social enterprises represented a welcome
challenge to the ‘monopoly organisational forms’ in the
NHS and to the ‘dead hand of the state sector stopping
people flourish’. One interviewee commented:
Social Enterprises and the NHS
5 Social enterprises: views from the field (1) national stakeholders
I don’t think any organisation, whatever sector it’s from,
has a right to deliver services simply by virtue of its
organisational form, and I think too often that’s the way
the debate runs. And I think social enterprises might be
a good way of showing that, you know, the core role of
the state has to be managing the system, rather than
necessarily providing everything (NVO representative).
A number of interviewees emphasised the fact that the
NHS already worked with small businesses in the form
of GP practices.
Many considered social enterprises more acceptable
than the private sector, given their social ethos and the
fact that any surplus was reinvested in services rather
than in private companies or going straight into
shareholders’ pockets. In this way, social enterprises
were seen as providing a ‘counterweight’ to the
privatisation agenda, combining independence with
public benefit.
One interviewee commented:
It does play into something which is not about privatising
the Health Service, but about sticking to the sort of
social delivery norms, and being able to reinvest that
money back into social good for the local community, or
health for the local community. And I think that fits in
very well with the ethos of a lot of people working within
the NHS (National policy commentator).
And another:
I’d rather see social enterprises taking over from the
NHS than profit making companies, because I do think
in the end that’s going to be better for people (National
policy advisor).
A key issue in relation to the provision of mainstream
services was the extent to which the NHS could
become a ‘brand’, a commissioning organisation,
overseeing a range of providers of health and
community care, including perhaps ‘federations of social
enterprises’ in order to overcome the piecemeal nature
of the sector. This was described by one interviewee as
offering ‘huge opportunities to convert public sector
bodies into social enterprises’.
As the private sector was unlikely to be interested in
providing the whole range of services, it was important
that support was given to a range of alternatives in order
to provide options for PCTs. However, there needed to
be clarity about how the market would be managed and
whether or not social enterprises were going to be
supported or protected in a competitive market.
On the other hand, those who supported the state as
the main provider of services, were concerned about
the fragmentation of the NHS, about market forces
influencing the delivery of clinical care and the likelihood
of increased transaction costs.
CHANGING PATTERNS OF OWNERSHIP AND ACCOUNTABILITY 21