Healthy disagreement

The Guardian‘s Patrick Butler offers an interesting response to yesterday’s NHS white paper in terms of its impact on social enterprise. He’s certainly right that the new government’s current conception of what a social enterprise is seemingly treads a fine line between positive woolly-thinking and euphemism.

Butler also suggests there’s currently “an ideological schism in the social enterprise movement about what a social business looks like” between  “a laissez-faire view that any company which can prove it delivers social benefit, however loosely, is a social enterprise” and the Social Enterprise Coalition’s view that: “that companies worthy of the name must adhere to certain criteria, recognised in a charter mark“.

I should probably be relishing the fact that this suggested split gives me a rare opportunity to sit round the libertarian bonfire in the ‘laissez-faire’ camp on an economic issue but my position’s actually a bit more nuanced than that – and some of the nuances are particularly relevant when it comes to healthcare.

My problem isn’t the setting of criteria for what social enterprise is. My problem is that this definition should be about ways of delivering products and services, and the social impact of products and services, rather than the legal structures and theoretical constitutional commitments of organisations.

For me, social enterprise healthcare is high quality healthcare, provided free at the point of delivery, on the basis of need by an organisation that operates to an agreed set of ethical criteria in terms of its treatment of patients, staff and the wider community. A not-for-profit company might not do that, a for-profit company that’s constitutionally able to give out more than 50% of its profits in dividends might do that.

I’m not arguing that outsourcing of healthcare is necessarily a good thing – I don’t think that more market competition is the only answer to the challenges facing the public sector – but, given that some of more outsourcing of healthcare is going to be happening, I want the social enterprise movement to concentrate on saying ‘this is what we can make happen that’s better’ rather than ‘this is how much profit we’re not giving away’.


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3 responses to “Healthy disagreement

  1. David I think you’re right in the sense of it matters more to get it right as this is a reality and it’s going to happen so it’s no good wringing our collective social enterprise hands for a long time. As a “movement” we have to embrace change, have influence in it and ultimately be part of the provision.

    I think I share the concerns of many however about “back door privatisation” of the NHS and that the term ‘social enterprise’ has become a very useful tool indeeed for the conservative government.

    The suspicion is this. That while the average person starting a small social enterprise sees social enterprise itself as a small way they can make a positive difference in the world government sees it a little differently!

    The suspected government interpretation goes like this:

    ‘What a good way to lessen the responsibility of government for public services and save money at the same time!’

    I could of course be completely and utterly wrong, only time will tell but do you think we might ask the government to come up with their own name for the organisational structures they want to run public services like the NHS.

    That way when services that work are lost to the public in the future the good name of social enterprise wont be tarnished.

    I honestly hope I’m wrong because in part I want to believe that we could have a government that doesn’t say one thing while actually meaning something entirely different.

    If as a “movement” we do take the procactive view it is a huge responsibility and we need to be prepared to fight for the real principles of social enterprise and it’s good name. It is a huge challenge!


  2. Guys, don’t forget the fundamental difference between social enterprise and social entrepreneurship. The NHS problem is that although they crave the liberation that social enterprise can deliver, they have a culture that means few if any social entrepreneurs will exist within half a mile!


  3. beanbagsandbullsh1t

    Martin, you make some very good points. If large chunks of our health system end up being by organisations that are social enterprises in the sense that, for example, some large housing associations are social enterprises – all the faceless bureaucracy of big government without the democratic accountability – then that definitely won’t be a good thing for anyone.

    Robert, I definitely agree that there’s significant cultural barriers to bringing meaningful social entrepreneurship to many parts of the NHS. Some of these are bad things that needed to be challenged – such as convoluted processes that have become disconnected from outcomes – and some are things that social entrepreneurs need to understand (such as the desire of, for example, nurses to get on with doing nursing rather than getting caught up in the exciting ideas of either politicians or social entrepreneurs).


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