What does the Big Society mean for health and social care?

The term 'Big Society' has been used to cover all manner of ideas, and many of us are hard pressed to define it. As for public perceptions, a recent survey for Ipsos MORI shows that although there is some awareness of the concept, there is little understanding of what it actually means.

Last week we held the first of a series of breakfast events at the Fund in an attempt to untangle the Big Society and what it means for the NHS. Inevitably, the debate raised more questions than it answered.

As one of our speakers, Matt Leach from think tank Respublica, made clear, the Big Society can't just be implemented like other policies. It's a vision, and, most importantly, a work in progress – an open-ended approach that aims to change perceptions about the roles of individuals and the state over time.

Mutualism and employee ownership are a defining feature of the Big Society, and last week's discussions examined how organisations can move from central control to control by individuals or local communities. Commentators pointed to the experience of businesses, such as John Lewis, to prove that empowered staff are better at cutting costs and improving productivity.

Ali Parsa, Managing Director at Circle Health Partnership – itself a successful employee-owned co-operative – argued that most organisations take ownership and power away from people who understand the business on the ground, creating endless chains of command that inhibit creative problem-solving. He pointed out that the professional services sector is one of the most successful in the UK and many organisations in this sector (accountancy firms, architectural practices, and legal firms) are partnerships.

So if mutualism, partnership or employee-ownership models are performing so well, why haven't they yet worked in the NHS? Other than the often cited Central Surrey Health, there are few examples of NHS provider organisations successfully moving in this direction (with the exception of general practices, where partnerships are common).

Some of the barriers are clear – pension and employment rights, as well as asset ownership need to be considered. Ali pointed out that employee-owned organisations also need the flexibility and freedom to bring in new talent and resources – difficult in a democratic operating model with devolved decision making. Neither flexibility nor freedom is of course exclusive to employee-owned models and it will be interesting to explore what other factors are at play and what NHS organisations will need to consider if they are to lever the benefits of employee ownership.