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The Government's NHS agenda may give rise to new
opportunities for NHS organisations to adopt a social enterprise
model and also for social enterprises seeking to provide a greater
array of health services as the commissioning market place opens up
to 'any qualified provider' to facilitate diversity of
supply and promote competition. We are already seeing NHS services
being spun out into social enterprises. This is not without
controversy and we have seen Gloucestershire NHS PCT retreat from
its decision to convert to a community interest company after a
campaign to halt the "privatisation" of NHS services
reached the High Court.
Those who have elected to go down this path see that it will
provide greater autonomy and reduce bureaucracy, with greater scope
for innovation. Furthermore NHS organisations are often criticised
for the polarisation of executive and frontline staff. It is
envisaged that a social enterprise model, which benefits from a
flexible constitutional framework, may better enable staff
engagement in an area which has previously only known top down
management. This approach might give rise to a sense of greater
ownership of decisions which affect the organisation leading
perhaps to greater staff incentivisation and engagement.
Whilst the social enterprise model may offer a number of
advantages, its adoption is certain to generate concern among staff
already skeptical of the motives behind the reforms. Understandably
NHS staff will be concerned about what a social enterprise will
mean to their employment conditions generally and their pension
entitlements in particular. Whilst social enterprises can sometimes
participate in NHS pension arrangements, this will not be possible
in all cases. In this environment those leading the charge will
need to work hard to convince staff of the benefits which may flow
from doing things differently and addressing staff anxieties
regarding the accusation of privatisation by stealth.
To be successful will require a more commercial approach in what
will undoubtedly be a competitive healthcare marketplace. For
smaller organizations to compete in tenders they will need to
leverage their position through collaborative working. This would
also enable valuable business skills to be shared among
organisations which might not be equipped from the outset to
operate in an open market environment. Fostering the necessary
management competencies will be a significant short-term challenge
for many fledgling organisations trying to get a footing in this
marketplace.
If the Government is serious about embedding a social enterprise
model within the NHS it will need to do more to win hearts and
minds, namely by supporting organisations at the early stages
through the provision of long-term contracts and providing greater
assistance in addressing staff anxieties concerning NHS pensions.
This will alleviate many of the understandable concerns of staff
who are being asked to participate in these new models.
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