The third sector and social enterprise in health: the way forward?
13 May 2008, House of Commons
- Harry Cayton, National Voices for Health & Social Care
- Mo Girach, St Alban's & Harpenden PbC Group
- Sir Muir Gray, Knowledge into Action
- Mike Parish, Care UK
- Commentary: Lord Mawson, Founder, Bromley-by-Bow Centre
This is the second in Civitas's series of debates, chaired by Professor Aidan Halligan, that look at some of the key themes, drivers and milestones in the Next Stage Review of the NHS currently being conducted by Lord Darzi.
Background:
With the focus of the Next Stage Review and the drive for world-class commissioning squarely on creating an NHS that is 'clinically-driven, patient-centred and responsive to local communities', social enterprise and the third sector more generally are once again being touted as a significant part of the solution. But what can it offer?
Resources from the debate:
Online Summary:
Unrealised potential
'The potential for social enterprise and not-for-profit organisations to contribute to health and well-being remains almost completely unrealised', surmised Harry Cayton.
The question is why? Social enterprise - as shown in personal examples such as SELDOC and Stahcom, led by Mo Girach, and Knowledge into Action, the brainchild of Sir Muir Gray - has much to offer.
'A more elegant structure' commented Sir Muir, social enterprise combines the 'Richard Branson and the Mother Teresa', as Mo Girach put it. In giving ownership and necessitating proper financial management, social enterprise should incentivise efficiency, patient-focus and a willingness to take a few healthy risks where the NHS classically fails.
Sixty per cent of health care is provided by cooperatives in Spain, yet the third sector and social enterprise remains almost completely under the radar in the NHS. Harry Cayton offered some reasons as to why:
Within the voluntary sector:
- A risk-averse attitude, particularly among the largest charities.
- A dependency culture.
Within the NHS:
- Procurement. The NHS doesn't know how to buy anything from anyone and the OJEU rules are stifling.
- Over-regulation of small-scale health and care services - an issue that came up time and time again in discussion. 'There's been a huge rise in project management and a decline in personal responsibility...we're engulfed by bureaucracy', commented Sir Muir.
- Financial disincentives to change. Short-term contracts, non-transferrable state pensions and the Quality and Outcomes Framework all work against innovation.
- A lack of radical behaviour.
Creating a level playing field
But Mike Parish offered a word of caution. While welcoming the not-for-profit sector with open arms, he cautioned that such organisations must have a good, long-term, quality and cost rationale.
'The point I want to make', he said, 'is that you can get great quality from the third sector, from the private sector and from the public sector, but you can equally get appalling quality from all of them'.
Sir Muir echoed this point. 'Nothing will change until we stop doing business the wrong way round...the third sector is important, but ultimately its success will depend on its ability to adopt a fundamentally different approach to the individual in patient care'.
Mike Parish saw the vital element as freeing up commissioning; releasing PCTs from an operational role 'where the default is urgent-for-today priorities' to:
- Build relationships and partnerships over the long-term;
- Create a level playing field for the third sector, social enterprise and the private sector vis-à-vis the NHS;
- Focus on value and quality.
Commentary
'The devil', Lord Mawson reminded delegates from his experience in Bromely-by-Bow, 'is in the detail....the government must grasp the implications of more entrepreneurial, organic, ways of working; and populations have to be persuaded they can make a real difference'.
Indeed, 'set us free' was the overwhelming message from delegates. Lord Mawson provided the following observations:
- Drill into the detail of consequences. I thought I'd find religion in churches, but I found them in the NHS - it's full of talk of health inequalities, making everything equal and fair, but it's the patients that pay the price.
- Create cultures that back success. Many people spring up who are very good at what they do, yet systems too often undermine their work. We need to reward them.
- Take a long-term view. It's about listening to people to make things work and above all about learning-by-doing.
- Grow together. Public vs. private and voluntary sector vs. private sector is an out-dated concept.
- Create an enterprise culture. Children need to breathe in the entrepreneurial traditions aged 6, not 16.
- Beware of politicians from all parties; the 'johnny-come-latelies' and the political culture based on 'come and go'. Five years is a very short time.
- Be a lot more radical. We have to move this on and think about how to cut out the bureaucracy, to get hold of problems and really learn and try to apply a solution.
- Quality leadership. We need to back people before structures.
- Recognise that health is not an illness service. People are healthier when they are empowered.
- Prove that you are better. Measurement will have limitations in terms of integrated, holistic responses to human problems, but we need to show how money's been saved and how much quality we're providing.
Please find a full summary text of the debate, with comments made in discussion from Charles Fraser, Daniel Green, Jenny Edwards, Dr Angela Jones, Dr Shirine Boardman, Nick Seddon, Major Ian Harris and Peter Mason here.
Any thoughts on the debate? Post them here.
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