There’s been an interesting debate kicked off recently about social enterprises being created to provide services that would have previously been done by the state/NHS. It seemed to kick off with a report by the trade union Unison, entitled "Social enterprises and the NHS: Changing patterns of power and accountability" (pdf). The essence was captured in the NHS Improvement Networks headline, though: "Clarity needed on ‘stealth’ social enterprise bodies".

The core of the report is that "the social enterprise
movement is changing, and that bodies are ‘becoming disconnected from
their roots in the co-operative movement, community-focused businesses
and regeneration activities’. Increasingly, they are being more widely
defined as organisations that reinvest surpluses into the health
community, such as foundation trusts or even private healthcare firm
BUPA, it says. The study claims this has led to confusion and a
reduction in public accountability.  And financial concerns could be
overtaking social enterprise’s original social mission".

This was then followed by several subsequent reports in Healthcare Republic (Study questions PCTs’ ability to commission social enterprise), Third Sector (Alarm as public sector forms new social enterprises) et al. It’s interesting to me having sat on a health/social enterprise roundtable recently where precisely these issues were being discussed: that if the primary motivation is responding to a contract/procurement opportunity (or advice from central govt), rather than a personal/social mission, then problems may lie ahead. Certainly, as SEC pointed out, the legal structures chosen often imply or demand community engagement / stakeholder involvement, and there is no doubt this happens in many cases. The question of the underlying motivation seems to be the issue for Unison, ACEVO members and others, though.

Certainly, SSE has always argued/advocated for a people-centred movement of social enterprise and entrepreneurship, and supporting those people to create and lead organisations to achieve their goals. We’ve also always emphasised that other must be open to the fact that such social entrepreneurs exist within the NHS (and the public sector) as well as outside of it / in communities and third sector orgs. Nor that opening up services to non-state providers is unilaterally "a bad thing": I met someone from Sunlight Development Trust recently, a community-founded, owned and managed organisation that is delivering increasing number of health services from its centre with success: surely something to celebrate (and replicate?).

But the concerns being raised do have some validity….what distinguishes social enterprise / entrepreneurship from enterprise and entrepreneurship is the ‘social’ modifier: the social mission that is primary. Generally, it has been feared that social enterprise will ‘allow’ the private sector to enter into public service delivery much more; this could prove to be true in future, but it seems that it is the public sector itself that is the biggest challenge (The public sector by another name?). Whether this proves the case in other sectors as well as health remains to be seen. Social entrepreneurs have much to give, as Cliff Prior of UnLtd makes clear in this New Statesman article, but a blanket approach to commissioning or delivery mechanisms will not help them. [Nor a gap between rhetoric and reality: see previous post]

There are no easy / clear answers here and, just as the sector boundaries are increasingly blurring, so this debate is not black and white. I am reminded of Dave of Busy Nurse  who left the following comment on another health-related post; Dave both left the NHS to found a social enterprise, but also had strong views on others considering that particular move:

"We left the NHS to form a social enterprise about 4 years ago and
there have been a small number of other SEs that emerged from the NHS
or were created to support the NHS. There has been nothing stopping NHS
organisations or teams forming into social enterprises for the last
dozen years but very few chose to.

Now there are hundreds of senior NHS managers interested in creating
social enterprises who had little or no interest in this a year ago. I
beleive that these are not all people who have had a "damascus like
revelation" but who are responding to organisational and political
pressures. As I said in the piece I think there are 3 drivers for many
of these and I am not sure that becoming an SE is the right solution if
they are motivated by "Looking impressive to political masters / Trying
to stay one-step ahead of the next organisational restructuring / Pure
cold-blooded knee-trembling fear".

When we meet up with other social entrepreneurs they seem to be
"real evangelists for the cause" and seem driven by the desire to
change the world, the desire to do things differently and a passion
about their local community or stakeholders. I believe that there are a
few like this within the NHS and I hope there will be more, but the
majority of senior NHS managers I come across are not like that at all."

To end positively, though, and for those who are keen to set new third sector organisations up in this field, the ever-reliable and well-informed (SSE Fellow) Chris Dabbs and Mo Girach of NHS Networks recently posted up a concise guide, entitled "Ten Steps to Starting A Social Enterprise in Health and Care" which can help steer people through the minefield….