VOL: 102, ISSUE: 39, PAGE NO: 41
communications manager at the Queen?s Nursing InstituteDiversity in the provision of public services is seen as a key component of public sector reform and the concept of contestability - the widening of the market to create more suppliers of services - is seen as the key means of achieving this. As well as the public sector and private sector business, social enterprises will be able to compete to supply services traditionally provided by the state. But what are social enterprises, and what are the implications of social enterprise for community nursing?
Diversity in the provision of public services is seen as a key component of public sector reform and the concept of contestability - the widening of the market to create more suppliers of services - is seen as the key means of achieving this. As well as the public sector and private sector business, social enterprises will be able to compete to supply services traditionally provided by the state. But what are social enterprises, and what are the implications of social enterprise for community nursing?
Social enterprises are businesses that have a social purpose at their core, examples of which include The Big Issue and Café Direct as well as many smaller ventures in fields such as recycling and social housing. Social enterprises run as profit-making businesses, but the crucial difference between them and traditional private-sector businesses is that any profits generated are used to further the social aims of the organisation.
Following the publication of Our Health, Our Care, Our Say (DH, 2006a), which identified social enterprise as one of the ways of taking the concept of contestability forward, the DH set up a Social Enterprise Unit. The unit aims to encourage the development of social enterprises that involve staff and service users in designing and delivering services tailored specifically to meet the needs of users.
So is the drive for social enterprise merely privatisation through the back door? There have always been independent practitioners in the NHS, such as GPs. The critical issue is that the values of the NHS are evident in how services are commissioned and provided (DH, 2006b).
Social enterprises created to fulfil particular needs within particular communities may be well placed to engage with the communities in which they work, often including those who may find it difficult to access or engage with statutory services. It has been argued that social enterprises combine public service values with entrepreneurial business skills to provide innovative solutions for seemingly intractable problems.
However, while many healthcare professionals are already highly innovative and have ideas for delivering services creatively, even entrepreneurial clinicians lack business skills and may have little knowledge of the legal and financial aspects of running a business. There are also issues relating to pensions for potential providers of NHS services: some types of independent providers are not accepted into the NHS pension scheme and it is therefore important that healthcare professionals understand any pension implications before setting up a social enterprise.
The key to the success or otherwise of social enterprise within the NHS is the development of the com-missioning function. Among commissioners there is a variable level of understanding of what social enterprises have to offer, how they operate, and their added value. Commissioners need to equip themselves with the knowledge and understanding of the whole spectrum of enterprise (public, private and social enterprise) in order to make informed commissioning decisions (DH 2006c).
Social enterprise has the potential to offer communities, patients, users and staff the opportunity to innovate and reshape services. However, the concept is new to many in primary care. Many clinicians need to develop business and financial skills to take up social enterprise opportunities, and commissioning requires strong and innovative leaders who understand the local community and workforce as well as the importance of clinical and organisational quality.
This article is based on the Queen's Nursing Institute briefing paper Social Enterprise, by Gill Collinson, director, Strategic Leadership Development Centre for the Development of Healthcare Policy and Practice, University of Leeds. The article is available at www.qni.org.uk.
Department of Health (2006a) Our Health, Our Care, Our Say.London: DH.
Department of Health (2006b) Health Reform in England: Update and Commissioning Framework.London: DH.
Department of Health (2006c) No Excuses. Embrace Partnership Now. Step Towards Change. Report of the Third Sector Commissioning Taskforce. London: DH.