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The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Develop Social Enterprise? Not in the NHS…

Filed Under (Health and Social Care Bill, Social Enterprise) by Paul on 21-11-2011

Q . Which Department if State will soon find itself as the only department forbidden by its own law from arguing for an increase in the size of the social enterprise sector?

A. The Department of Health.

In July 2010 the Government published a white paper which stated their aim to make the NHS the largest set of social enterprises in the world. A few people – including myself – felt this was a little over the top, but new governments often seem to want to go further and faster than their predecessors. So a little licence is allowed.

The Department of Health under the previous Government had a unit responsible for developing social enterprise and the voluntary sector with a view to helping them win contracts to provide services to NHS patients. Whilst this new Government obviously wanted to go further and faster, they already had an organisation and some policy to help this acceleration.

All so normal really, and a core part of policies aimed at increasing pluralism of provision for NHS patients.
Over the autumn and winter while, as readers of this blog will recall, the Government seemed to undergo a strange vow of silence about explaining its reforms current NHS providers fought back against this policy of pluralism. In April the Government called a halt and asked the Future Forum to come up with some new policy.
The part of the Future Forum examining choice and competition argued that the greater choice necessary would lead to greater pluralism of provider.

In responding to this, because as you will remember the Government was ‘frit’ about the row they had got into with the NHS, the Government came up with a policy which said they would ‘outlaw’ any Minister ever arguing for an increase in the size of any of the three sector providers – public, private or third sector.

From that day onwards this ‘radical’ Government not only had a policy of freezing the proportions of these sectors as they are at the moment, but were going to make it illegal to argue for any increase in the size of any of them.

In July 2010 the Government wanted the NHS to become the biggest social enterprise sector in the world.

In June 2011 the same Government makes it illegal to have that policy in a White Paper.

This in itself is pretty weird.

But now, as the Health and Social Care Bill has been amended by the June rethink, the implications of the Bill for the social enterprise sector becomes clear. The Government has introduced amendments into the Health and Social Care Bill “to outlaw any policy to increase the market share of any particular sector of provider” and this coming Tuesday these amendments will be under discussion in the House of Lords.

The voluntary and community sector currently only delivers a tiny proportion of NHS Services (the NAO estimated that over 2007/8 PCTs spent less than 0.5% of the NHS budget on commissioning services and support from the voluntary sector) but where it does, the Government has long recognised that it can bring benefits to public services, such as empowering service users, engaging those most disadvantaged or excluded and promoting service user voices.

Leaving aside the revolutionary zeal of making the NHS the biggest social enterprise sector in the world, for the past few years the Government, and people throughout the NHS, have sought to build the capacity of the voluntary and community sector to deliver health services and support. On occasions that might mean supporting tiny charities and community groups to build their capacity, or supporting NHS staff to form new social enterprises to deliver services. The current Government has committed to continue such capacity building, and many PCTs, clinical commissioners and people in the Department of Health or NHS Commissioning Board will want to be able to continue to act in a way that is now a traditional part of how the NHS works with and supports charities and community groups.

The Department of Health now believes that the Health and Social Care Bill that it is passing through the Lords at the moment will make it illegal for the DH  to go on building the capacity of the social enterprise sector. If the Government were to fund that process it would be a policy to increase the “market share of any particular sector of provider”. People in the NHS Commissioning Board and the wider NHS would interpret the Health and Social Care Bill as meaning that capacity building and other policies supporting the development of voluntary and community organisations would, once the Bill is passed, become illegal.

Voluntary sector organisations have already had conversations with DH officials suggesting that programmes/funds currently in place to support themand the community sector would need to be discontinued once the Bill has passed.

Examples of Department of Health initiatives that could be affected include:

  • various aspects of the DH Voluntary Sector and Social Enterprise Programme, which was set up to maximise “the extent to which third sector organisations are able to achieve their full potential”, for instance by tasking officials with ensuring good engagement between the Department, the NHS and voluntary/community groups and charities
  •  the Social Enterprise Investment Fund, which provides investment for social enterprises to start up, grow and develop in order to deliver NHS services and
  • the Health and Social Care Volunteering Fund, both the local and national programmes, which support volunteering in health and social care.

So to recap. We now have a Conservative led Government that is passing a law to make it illegal for one of its Department of State (the DH) to increase the size of the social enterprise sector in the NHS.

This would make the Department of Health the only one in Whitehall to effectively outlaw such support for the voluntary and community sector and social enterprise. Most other departments will have similar programmes to those above aimed at increasing social enterprises in their area of concern.

So the Government would be in the position of having a policy for the whole of the rest of society while having passed a law to make it illegal to carry out that policy in the NHS.

This is truly weird.

I am sure that the Government will say that this was not the intended consequence of their Bill. But the problem for them is that the lawyers who have been constructing the Bill and its meaning come from the Department of Health – and it is the Department of Health officials who say that this Bill will make it illegal to carry on building capacity.

So you would imagine that they probably know what their own law will and will not make illegal.

If you were a social enterprise that started up last autumn in order to become part of the “largest social enterprise sector in the world”, you might feel a bit let down a year later to find that the DH is about to become the only Government department that is legally not allowed to help you gain business.


5 Responses to “Develop Social Enterprise? Not in the NHS…”

  1. Thank you Paul for confirming what I thought – but couldn’t quite believe. Let’s hope that the Lords will rally to sort this one out along with all the other ‘unintended consequences’ that patients, the NHS and civil sector will otherwise be grappling with.

  2. […] are plenty of other factors affecting the opportunities for social enterprises to deliver public services but this is hopefully […]

  3. It is an interesting position. I am setting up a social enterprise from within the nhs, specializing in marketing and engagement services that make that no decision about me without me a reality. Social enterprise is the perfect fit – an independent quality provider that can plug the gaps at local level that the new nhs will leave behind, but with a commitment to social good. Many other services could follow suit. Indeed, the new national comms organization may be a social enterprise. It would be perverse if this bill would mean that ccgs could not commission services from staff responding to the new market. it strikes me that this is yet another example of how this bill plays fast and loose with the careers of dedicated staff who, despite interference and incompetence, have created a pretty impressive health service. th bill has led to the destruction of the nhs at many levels. But its too late now. we will adapt to new markets and get by, knowing like many other suppliers that the market where we could have the biggest impact is in freefall. it is a huge, huge shame.

  4. If this wasnt so sad it would be funny, this bill is in danger of suffocating the expertise required to develop quality sevices outside of the NHS. I am hoping this is just some kind of legal anomaly that will be sorted in due course but previous experience leads me to have serious doubts

  5. […] term blog readers will remember that their Lordships debated this issue in November 2011 and that I commented on the issue at the time. In that post I asked if the Department of Health would become the only Government department […]

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