I was up in Nottingham last week for the Fit for the Future conference on the role social enterprise in the future of health and social care services. The conference, organised by Social Enterprise UK in parternership with social enterprise events organisers, Sensevents, brought together a range of health experts and social enterprise leaders to survey the landscape of healthcare in the UK. It’s a landscape that’s seen plenty of upheaval since the arrival of the Coalition government in 2010.
In the good old days social enterprise conferences we’re top heavy with enthusiastic people making outlandishly optimistic statements about their ability to change the world. Nowadays you can avoid that stuff entirely if you don’t go to the session on social investment. Everyone else is busy getting to grips with the grim reality of what happens when the party’s over.
Bob Ricketts from the Department of Health set the constructively sombre tone for the day with his keynote address. He began by pointing out that ‘nobody owes you a living’ before explaining ‘hospitals will close but it’s worse for you (social enterprises) because you don’t have the political clout’. His message for social enterprise might not have got worse after that but it didn’t get much better. He emphasised the need for social enterprises to establish relationships within the new structures being established under the Health and Social Act, while acknowledging that the changes give new Clinical Commissioning Groups major scope for deciding how they use competition in the commissioning of services.
He noted that, in terms of commissioners’ ability to favour providers offering greater social value over private or NHS alternatives that social enterprises “shouldn’t just accept an argument from commissioners that ‘the law won’t let us do that'” but said his big worry around social enterprises in healthcare was that many social enterprises who left the NHS under the Right-to-Request scheme might not have the commercial skills to keep contracts when they come up for renewal (or to expand their businesses).
An additional challenge was that, Ricketts felt, social enterprises have not yet won the argument that social enterprises are not privatisation.
Against this relatively gloomy backdrop, other speakers offered a more positive outlook in terms of the situation for existing health and social care social enterprises. Geoff Walker, CEO of leading social care social enterprise, Sandwell CCT – who have a turnover of £18 million and a staff of 700 – endorsed Ricketts’ view that social enterprises don’t have a divine right to commissioners’ business but emphasised that, with a highly motivated staff team providing good value for money services, there would be plenty of chances for social enterprises to win contracts. He demonstrated the diversity of his company’s approach by explaining that they had set up training centre that trained unemployed young people to work in call centres, and this had generated enough profit to pay for dementia care services that were needed but did not receive public funding.
At the workshop on ‘Creating and Embedding a Culture of Enterprise and Social Innovation’, Jo Pritchard, Co-Director of Central Surrey Health – regarding of one of the most successful NHS spin-out social enterprises – explained her organisation’s approach to involving their staff team in decision-making. They have a ‘co-ownership council’ made up of a cross-section of staff from across the business who set the company’s operational strategy. They also devolve budgets to the lowest possible level so that staff have the opportunity to take decisions (and take responsibility for them). The organisation has managed to make significant savings while increasing productivity primarily through implementing changes suggested by frontline staff.
Unfortunately, being a really successful, and winning one of the government’s Big Society Awards, has not been enough for Central Surrey Health to hold off competition from bigger players in the private sector. In response to a question from the audience, Pritchard offered a few thoughts on her organisation’s controversial failure to win the contract to deliver community services in south west and north west Surrey – when they lost out to a company with less relevant experience in healthcare but more relevant experience in being backed by a massive conglomerate.
She explained that: “We got the best score. We were the top bidder. We lost on a technicality which we got to the high court on.” Citing the difficulties facing social enterprises without a significant asset base up against subsidiaries of large private companies she added: “If you’re part of a big commercial enterprise, all you need is nice letter (from your parent company).”
The overall picture that emerged from the conference is one of there being everything to play for – in the sense that, in the coming years, we’re likely see £billions of public funding for healthcare spent outside the NHS – but that, in most cases, social enterprises are not likely to win.
Some of the factors in whether more health and social care services end up being delivered by social enterprises are down to the social enterprises themselves – on whether they can demonstrate that they offer something specifically different and better that public and private sectors can’t provide.
Other challenges are more political. Can the social enterprises movement successfully make the case to trade unions and other sceptics that social enterprise either does not amount to privatisation or is the least worst option in the long-term?
What social enterprises can’t control is the approach of public sector commissioners when they’re deciding how to spend public money. As Sandwell CCT’s Geoff Walker noted at the conference, social enterprises shouldn’t expect to get contracts for being nice people. But it’s equally important that social enterprises aren’t excluded from the marketplace because they’re not backed financially by the state or a large private company.