Yesterday Michael Lloyd, a retired railwayman from Stroud set off to the High Court to challenge a decision by NHS Gloucestershire to outsource community care to a social enterprise.
The basic gist of his argument, and that of Stroud Against the Cuts, the organisation which backed him, seemed to be that the NHS is the only organisation that ought to provide any health services to anyone.
Reading the comments made by Stroud Against the Cuts, I came away with an impression that no one there really knew much about social enterprise. They’d seen something unfamiliar, and decided they didn’t like it.
They may be right, of course. Social enterprise might be worse than the existing PCT provision. But the experience of several health leaders I’ve interviewed when writing stories about mutualisation suggest the opposite: by and large, they think it’s a massive improvement.
One revealed that now her organisation has spun out, referrals from doctors are finally being made by email, instead of a combination of handwritten notes and fax, and therefore the service was, for the first time, sure it was seeing the people it was supposed to. Another revealed that spinning out had allowed her to spend an extra two days a week running her organisation, instead of sitting in pointless meetings.
So this judicial review raises a couple of things that have to be addressed if the process of encouraging spin-outs is to continue.
First, there is a very serious need to ensure that the independent social enterprises created out of NHS bodies are able to hold onto their contracts, and aren’t out-competed in the future by private enterprises.
This means they need access to enough capital to bid for contracts, and they need a commissioning environment that allows them to compete properly. It probably requires public sector commissioners with a lot more skill than they’ve got at present.
Second, if you spin out, you have to take the public with you.
In areas where social enterprises have spun out successfully, they’ve won support. They’ve engaged with patients, with politicians, with health professionals, and with the local population, and they’ve convinced them that the change is for the best.
People have a powerful attachment to the NHS, and a powerful fear of change. They don’t like privatisation, and they distrust the competency and honesty of commissioners. It takes a lot to convince them, and quite a lot just to make them listen in the first place.
If people are to be convinced about the benefit of social enterprise, it has to be better than the alternative. But more than that, it has to look better, too.