The future for health and social care

Almost a third of Social Enterprise UK members operate in health and social care, often involved in some of the most innovative and pioneering work

  • Guardian Professional,
    Plymouth, where social enterprises have contributed to a dementia hub. Photograph: Andy Fox/Loop Images/Corbis

As the recent party conferences and Scottish referendum have proved, health and social care are at the centre of political attention – and will be crucial in general election campaigns. This is with good reason: we are in a period of challenges where health services are concerned. Many NHS trusts are already significantly in deficit, and the strain is beginning to show across the country.

What is the role of social enterprises and charities in this context? They have a long history of helping to influence, support and deliver services across health and social care; sometimes doing so in partnership, sometimes “outside” services, sometimes fundraising for research, and other times campaigning for change. At Social Enterprise UK, almost a third of our members operate in health and social care in the broadest sense.

What we can see is that changes on the commissioning side are bringing challenges for organisations on the ground. Where once they had one major commissioning relationship, now they may have several; where their contract sat with one organisation, now it may have been divided by service or geography; where their contract was simple and “block”, it may now be heading towards personalisation. This requires more capacity, more relationship-building (and management), and sometimes completely new skills. For more niche providers, larger and larger contracts can simply mean they miss out, or have to quickly find the right sub-contracting arrangements. For others, it has meant a wholesale reinvention of their model of working.

There are also challenges of finance. While many services are delivered externally by charities and social enterprises, very few of the buildings and assets have been transferred with those contracts. This means they are often limited in what they can raise financially to grow, or building on their existing work. Shorter contracts with tight budgets from commissioners are also placing pressure on cash flow and working capital at the frontline.

But there are opportunities in this scenario too. Social enterprises are often involved in some of the most pioneering and transforming work helping reduce the pressure on acute services through social prescribing such as Wellbeing Enterprises in the north-west of England or telehealth systems, including Seqol in Swindon. They have also helped deliver on the promise of integration, as with integrated mental health services by Navigo in Grimsby, or the centralised dementia hub by Plymouth community healthcare, and are building early intervention partnerships, such as Nottingham city care partnership, which led a £45m initiative for children up to the age of three across the city. All this demonstrates the possibility of doing things differently, and the need to combine savings and efficiencies with genuine transformation and reform. This requires flexibility and often foresight on the part of the commissioners.

On the commissioning side, the introduction of the Public Services (Social Value) Act holds out the potential for precisely some of that new thinking. Many clinical commissioning groups are already working with their local social enterprise and charity sector on social value priorities in healthcare. Nationally, the Sustainable Development Unit and Cabinet Office are driving forward conversations with Public Health England and NHS England on their guidance on social value. And there are lots of examples of good practice from local authorities and housing associations, which are themselves key players in a brave new world of integrated, patient-centred services.

This needs to be the message sent out by social enterprises and charities: we are doing a huge amount already, and creating a great deal of social value. Our reach into communities, expertise and social purpose have made us natural partners to the NHS. But we are also key partners in helping shape, design and deliver the future of care – preventative, integrated, personalised, engaged and effective, and always with the patient at the heart.

Social Enterprise UK is hosting its sixth annual Fit for the Future conference on Tuesday. See the hashtag #fitforthefuture


One Response to The future for health and social care

  1. Chris Pearson-Denial says:

    Good to see that the role of Social Enterprise is being recognised. I know that, personally, I would like us to have the chance to do increasing pro-active and preventative work with carers. Without those millions of unpaid carers out there, services would be even more swamped, and waiting for them to hit crisis level in their roles is not the way forward. Carers of people with dementia go largely unrecognised, after all when they are ‘on-duty’ 24 hours per day, they have little time for campaigning. So it is good to know that people are raising their profile. We all need to do our bit to ensure that seamless and integrated quality services are there to ensure that neither people with dementia, nor their carers are slipping through the net or suffering the undue stress of ‘trying to find the right person to talk to’. Hopefully at Navigo we are fighting hard to ensure that this does not happen and that we continue to strive for the services we provide to be those we would like to see for our own families.

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