The Government's NHS agenda may give rise to new opportunities for NHS organisations to adopt a social enterprise model and also for social enterprises seeking to provide a greater array of health services as the commissioning market place opens up to 'any qualified provider' to facilitate diversity of supply and promote competition. We are already seeing NHS services being spun out into social enterprises. This is not without controversy and we have seen Gloucestershire NHS PCT retreat from its decision to convert to a community interest company after a campaign to halt the "privatisation" of NHS services reached the High Court.
Those who have elected to go down this path see that it will provide greater autonomy and reduce bureaucracy, with greater scope for innovation. Furthermore NHS organisations are often criticised for the polarisation of executive and frontline staff. It is envisaged that a social enterprise model, which benefits from a flexible constitutional framework, may better enable staff engagement in an area which has previously only known top down management. This approach might give rise to a sense of greater ownership of decisions which affect the organisation leading perhaps to greater staff incentivisation and engagement.
Whilst the social enterprise model may offer a number of advantages, its adoption is certain to generate concern among staff already skeptical of the motives behind the reforms. Understandably NHS staff will be concerned about what a social enterprise will mean to their employment conditions generally and their pension entitlements in particular. Whilst social enterprises can sometimes participate in NHS pension arrangements, this will not be possible in all cases. In this environment those leading the charge will need to work hard to convince staff of the benefits which may flow from doing things differently and addressing staff anxieties regarding the accusation of privatisation by stealth.
To be successful will require a more commercial approach in what will undoubtedly be a competitive healthcare marketplace. For smaller organizations to compete in tenders they will need to leverage their position through collaborative working. This would also enable valuable business skills to be shared among organisations which might not be equipped from the outset to operate in an open market environment. Fostering the necessary management competencies will be a significant short-term challenge for many fledgling organisations trying to get a footing in this marketplace.
If the Government is serious about embedding a social enterprise model within the NHS it will need to do more to win hearts and minds, namely by supporting organisations at the early stages through the provision of long-term contracts and providing greater assistance in addressing staff anxieties concerning NHS pensions. This will alleviate many of the understandable concerns of staff who are being asked to participate in these new models.
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