Social Enterprises and the NHS - Unison

That was one of the other reasons for doing this, was to
try and keep the local responsiveness that we’ve got
in... We’ve performed well for the last two or three
years, and when you’re doing well, you don’t want to
have to drop back to the lowest person and drag them
along with you, it’s not a good feeling is it? (Practice
manager).
(vi) Increasing patient and public involvement
There were many criticisms of a lack of accountability
and of meaningful public involvement in primary care. It
was now accepted across the political spectrum that
local people should be involved in health care decisions
in the local area. One of the early protagonists in one of
the case studies emphasised the importance of the
public becoming closer to decision-making in primary
care, being involved in developing new pathways of
care, and that organisations should demonstrate their
accountability to the public.
From my point of view, I was hoping to achieve
something that has been out of our grasp so far, and
that is real and meaningful public involvement in policy
developments in primary care (Lay member of Board).
There was concern among a number of interviewees
that health care should be kept local and linked in with
local communities, rather than contracted out to multinational
corporations with their headquarters a long way
from where services were being provided.
Well I mean a private company does not have this public
involvement aspect, does it? I think the public
involvement aspect is crucial, you know, it’s like listening
to your customers, or the customers having a real say in
what services they’re receiving (Lay member of Board).
A clinician from the same case study emphasised the
importance of the public being involved in the
organisation from the beginning, being part of the
board, agreeing over priorities and the reinvestment of
savings, ‘being signed up to the whole ethos of the
organisation’. Practice-based commissioners needed to
carry the public with them.
I think they will come up with ideas, I think they will help
implement those ideas, and I think they’ll help sell those
ideas. I think they will be quite useful in the sometimes
difficult discussions we may have with hospitals, say
where we want to do something different from how we
did it before, and were removing some service. I think
the public may have a very key role to play within that,
as I say. I would hope that if this works, maybe even the
public helps us to some extent with the responsibilities
(GP and Board Director).
It was recognised that the involvement of local patients
would be more difficult to achieve in inner city areas and
this would be reflected in the different organisational
models for social enterprises in primary care.
Social Enterprises and the NHS
6 Social enterprises: views from the field (2) local stakeholders
(vii) Empowerment of professionals
The theme of empowerment of professionals, the public
– and sometimes both – ran through the local case
studies. As one interviewee commented:
Well that, I think, is something that the executive team
at… were past masters at. One of their greatest goals
was to empower people to… make sure people were
informed and so on. Now you’d have to ask the staff
whether they succeeded in this, but certainly the early
ethos of the executive group was one of empowerment
and inclusion (Advisory Council Member).
A democratic structure should result in greater clinical
engagement in the development and implementation of
pathways of care and a further impetus to improve
practice.
If they develop a particular pathway or policy, it’s much
more likely to get embedded in local practice and affect
patient care, because it’s been agreed as a priority, and
the implementation has been by peers (GP and Chair).
It was also pointed out that staff involvement was, in
any event, the basis of good management practice and
of a successful business.
(viii) Addressing gaps in NHS services
The failure of the NHS in tackling inequalities in health
and meeting the needs of marginalised groups was
particularly emphasised by the healthy living centre. One
interviewee commented that:
The traditional statutory services have always had
difficulties in structuring themselves to reach out like
that, to marginalised groups, whereas a centre like
this… we’ve got much more flexibility so that we can
work closely on the ground with local community groups
and local people to identify what they want, and provide
what they want, rather than a much more kind of
restrictive or standardised kind of thing that you would
traditionally get through the Health Service (Finance
Director).
The healthy living centre had been developed to create
an environment in which local people were better able to
take responsibility for their own health. There was a gym
which was also used as a pilot for community-based
coronary rehabilitation (subsequently more widely
adopted in the area) and for people with mental health
problems.
(ix) Flexibility and innovation
A concern with flexibility and being able to innovate was
important to interviewees, although it was also
recognised that there were already many flexibilities
available to the NHS which were not exploited. It was
argued that decisions could be made and implemented
quickly outside of the NHS bureaucracy and that the
executive teams had a greater degree of freedom than
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