Social enterprise in health care: Promoting organisational autonomy and staff engagement

The government has proposed to transform the NHS into the largest social enterprise sector in the world. But what organisational and leadership changes are needed to make this vision a reality?

With insights from early social enterprise adopters, The Kings Fund, have produced a new paper "Social enterprise in health care: Promoting organisational autonomy and staff engagement", which explores the benefits and challenges of implementing this organisational model.

The paper acknowledges Co-operatives UK recent publication: Time to get serious: International lessons for developing public service mutuals which identifies some key factors for success, learning lessons and questions that are relevant for the development of new co-operative models in the UK.

More recently Ed Mayo, Secretary General, Co-operatives UK warned that "There's a yawning gap between theory and reality on public service reform".  In the article he says "that we have to realise that not everyone is able – or indeed willing – to set up a business, mutual or otherwise. There will really be some challenges for public sector workers setting up new co-operatives. We need to ensure that we can provide real help which will guarantee that they are supported through this process, if indeed that's what they want to do. Any new co-operatives formed need to enshrine the co-operative values and mustn't be allowed to be 'fake mutuals'."

"Co-operatives can only succeed – and in the public sector success is essential – if they are independent enterprises, controlled by their members – staff and users.  Currently, it seems to be that there is a gap between national policy and local practice, with a lack of understanding of the benefits of co-operatives delivering public services amongst local authority councillors and officers."

Rachel Addicott, author of "Social enterprise in health care" attended Co-operatives UK Health roundtable late last year which was attended by 17 practitioners.  The event highlighted some of the key factors for success but also acknowledged some of the challenges for co-operatives in this sector.

In the White Paper Equity and Excellence, the government announced its ambition to establish the ‘largest and most vibrant social enterprise sector in the world’. Social enterprise in health care explores the organisational and leadership changes that will be needed to support the development of social enterprises and makes recommendations that will be of particular interest to policy-makers and health care providers.

Based on the responses of a small group of directors of social enterprises and chief executives of acute and mental health foundation trusts, this paper explores the motivations for becoming a social enterprise and whether their ambitions have been realised in practice. In particular, the paper looks at the impact of social enterprises on the financial framework and on employees’ attitudes. One of the aims of the health reforms was to give greater autonomy to providers, but there is considerable uncertainty about how such organisations would develop and function. Interviews with the chief executives of foundation trusts showed they were receptive to the social enterprise model in principle but had concerns about the scale of change needed  and about whether it would detract from the underlying intention  – increasing staff engagement in decision-making.