Meeting the demands of public health with social enterprise

In the last few decades, much of public health discourse has been concerned with the debate between some of the benefits of a private sector approach versus the ‘free at the point of use’ principles guiding the NHS.

However, it really shouldn’t be viewed as such a simple dichotomy between the two.

What many are beginning to realise is that it’s possible to meet the current demands the public place on health services through combining the best of both worlds. One such approach is that of social enterprises.

The benefits of ‘private’ and ‘public’ approaches

Right off the bat, it’s important to establish some of the benefits of either approach.

Firstly, the private sector approach. The NHS has come under a lot of strain in terms of its resources. This is primarily due to a major increase in demand for services, due to demographic changes such as a rising – and an increasingly ageing – population (Britain’s over-65s now outnumber people under the age of 16 for the first time). Furthermore, this has been compounded by health epidemics such as obesity, diabetes, and heart disease. Because of this, the NHS is faced with a number of new and unique challenges. In the absence of additional funding, many trusts are turning to the private sector.

It might seem obvious, but what the private sector approach allows us to do is innovate in response to these new challenges, thanks to the reduced red tape of the sector and the much more flexible availability of funding. Furthermore, small-scale private providers are able to create specific, local solutions in service areas – something the typical top-down approach of the NHS falls flat on, even with strong local trusts. In the short-term, the private sector approach can allow us to effectively meet these new challenges through flexibility and innovation.

Many argue this sits in conflict with the free-at-the-point of use nature of the NHS. To an extent, this is true, as funding diverts more and more towards private providers and away from state-owned health assets. However, this isn’t the full picture. It is fully possible to retain the universal free-at-the-point of use nature of British healthcare in the long-term while meeting short-term challenges in part through the private sector approach. Good strategy here depends upon utilising the advantages of both approaches – without losing out.

Developing new health strategy through social enterprises

What many commentators overlook is that trusts are not only outsourcing services to private providers, but also to many charities and social enterprises. As Social Enterprise UK describes:

Ambulance"Social enterprises are businesses that trade to tackle social problems, improve communities, people’s life chances, or the environment. They make their money from selling goods and services in the open market, but they reinvest their profits back into the business or local community.

They are therefore independent, often owned by their stakeholders, and plough the majority of their profits back into their community or industry of involvement. While social objectives are considered by many private companies, they are central to social enterprises. So what does this mean for health?

Well, first off, many social enterprises aim to engage both staff and patients in the formulation and delivery of services. This is evident in their structure, but also in the fact that many of them work in partnership with other groups and charities, often outside of the health service. This gives them a greater advantage in meeting specific local demands, and overcomes the issue of shareholder-owned private companies being divorced from the people at the frontline of care.

As well as their ability to generate profit and additional revenue, this makes them much better-placed to innovate than traditional state-owned services. However, the fact that they are bound by their model to reinvest this profit into their organisation means the money doesn’t just disappear into the pockets of private shareholders. What it means, effectively, is that it’s in the interests of social enterprises to work for the benefit of patients and service users, just as it is for the NHS.

A good example of an effective social enterprise is Inclusion Healthcare. Not only were they awarded an ‘Outstanding’ rating from the CareQuality Commission, but they have also worked hard in providing care for asylum seekers and people with mental health problems – two groups that are too often overlooked by other provider models.

Social enterprises show us it is truly possible to move past the problematic debates of the past and provide excellent frontline care, simply by triangulating and mixing these other approaches.

Photo by Lydia