Social climbing

Released 11/05/2010

by Matt Jane

Ben Saer wonders if too many social enterprises will undermine the NHS

Welcome to a world of Social Enterprise - the hot new idea from the Department of Health. Well, actually, they're not that new, but healthcare social enterprises are springing up like mushrooms: 6,000 mushrooms at the last count.

On the face of it, it's quite a seductive proposition for primary-care staff. Dear colleagues: just tell your PCT your great new idea for a health or social-care service and, hey presto, a brand new, cost-efficient service could spring up down the road, all thanks to you.

Let's look at the positives. It's good to encourage local entrepreneurial thinking. Why shouldn't gaps in services be spotted and tackled by staff on the front line? The move from decentralised control is already in third gear, so what's the problem? Idea-generators will be rewarded by being members of their new organisations. Win-win, right?

Wrong. Possibly. It could be argued that social enterprises are a form of charitable privatisation of the NHS by the back door. They're independent organisations. This begs the question: it is right for the Department of Health to surrender control of essential community services? There may be checks and balances in place to ensure healthcare social enterprises are run properly, but what are they? Who's in control?

The NHS is a sort of social enterprise itself, albeit without the precise legal structure required. The social-enterprise model could fragment the NHS. What next? Could some GP practices reinvent themselves as SEs? Hospitals?

By grouping services in this way, where communities become members of the health and social care services that affect them, we might be in danger of outsourcing too much responsibility and leadership. In the old days, weren't we just told what to do?

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