There is a thoughtful piece in the Guardian healthcare network by Allison Ogden Newton about social enterprises and community care (at http://www.guardian.co.uk/healthcare-network/2012/feb/23/nhs-reform-capital-overshadows-debate).
I think it is clear that there is a consensus that we need more community-based services to prevent un-necessary hospital admissions, to treat patients more appropriately.
I will also agree that in order to foster innovation, we need new community-based organisations to work with the NHS as it requires fresh perspectives and new ways of doing things to find new answers.
However, I disagree that competition is necessary to achieve this. I also have concerns about the NHS relying on non-public provision for the long-term delivery of services.
It isn’t necessary for new organisations providing care for the NHS to be competing with other providers of care. We can do this just as we co-operatively. The NHS can buy care from social enterprises and other non-public bodies without the need for them to be competing with one another. I have no problems with the idea of such services being commissioned, and their impact and effects evaluated through careful research.
Equally it seems to me to be unwise, either for social enterprises or the NHS, for non-public providers to become dependent on public funding. It’s a bad idea for the NHS in case those providers run into financial difficulties, and which will result either in them having to be bailed out by the government, or patients face the disruption of having to be reallocated to other providers, possibly in systems which don’t have the spare capacity to support them.
It also seems like a bad idea for social enterprises to become dependent on public funding – their vibrancy is surely based on being able to be sustainable without becoming dependent on the state. If social enterprises are dependent on the state for financing, they might as well be public bodies. The private health sector is, I read, already getting 25% of its revenues from the public purse, so effectively sustained by it. That doesn’t strike me as being healthy for either public funders or private companies, and repeating the error with social enterprises would be short-sighted.
My suggestion then would be a more research-driven approach – asking social enterprises to provide services to the NHS which would be evaluated, and if successful, rolled out across the system, but funded publicly. There is no intrinsic reason why public funding should prevent innovation – that’s about good management, and there’s no intrinsic reason why good management only exits outside the public sector.