Plugging the gaps in our national health system

Nearly a fifth of UK social enterprises focus primarily on health or social care. Could they help ease the NHS crisis, wonders October ’14 Associate, Rahul Agarwal.

Why is the National Health Service facing problems?

My first placement, at the North East London Commissioning Support Unit, underlined the major pressures the NHS faces:

• It needs more capacity to handle increased demand;
• It needs a more transparent and accountable culture;
• It needs to improve value for money and productivity.

All of this while maintaining quality — not easy, with an extra £8 billion needed by 2020 fill the looming funding gap.

I don’t have the solution, but I did see a glimmer of hope in social enterprise. 18% of UK social enterprises primarily focus on health or social care; many have been “plugging in” or reinforcing areas of the national service for years. The government, meanwhile, has invested £120 million in 6000 social enterprises since 2007, while its Social Value Act requires commissioners to consider local economic, social or environmental benefits in awarding public contracts — benefits that most social enterprises naturally provide.

What do such organisations offer our health system? Here’s my take:

• Innovation: social enterprises develop new models of delivering care. One example is Wellbeing Enterprises, which helps people learn how to improve their own wellbeing, and promotes ‘social prescription’ to reduce unnecessary visits to the emergency ward.
• Involvement: they are locally embedded, so can respond to people’s needs with bespoke services through their community networks, which the NHS often lacks. The mental health service Stepforward UK, for instance, places therapists in schools and tailors services to children’s specific needs.
• Improvement: they are resilient, self-sufficient and adaptable. Bromley Healthcare, which runs various community services, has won multiple awards for its high performance and ensures continuous improvement through clinician and patient contributions on how it should be run.

The challenges outlined by the King’s Fund in 2011 remain relevant — but are, I believe, more a question of perceptions which can be overcome.

For instance, some worry that social enterprises are privatising the NHS. But if the NHS is to contract services to other providers, social enterprises at least offer ‘patient first’ values and profit that’s reinvested into the health system, rather than landing in shareholder pockets.

Secondly, they are often seen as small scale and less competitive compared to the NHS Trusts that run large hospitals. Social enterprises cannot and should not replace the complex services of an NHS Trust. However, the Social Value Act — though not perfect — is opening up space for smaller providers able to provide some patient-centred services more efficiently.

Finally, social enterprises lack a track record. Yet they measure their impact at a local level effectively; many health and social care ventures achieve high ratings on the SE100 impact index. Social enterprises may be a tiny proportion of the overall health sector. They now need to advocate, collaborate and expand collectively, to get the attention they deserve.