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

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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.

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paul massey

somerset partnership
Comment date
17 November 2010
After two years of trying to reach our Foundation Trust Membership, I have begun to look at new approaches like the vision of the Big Society. Constituency Meetings attract few Members. Keynote speakers on relevent subjects like Carers Issues do little better.Our Members' Newsletter is largely a vehicle for the Trust Managment. I have yet to meet a Member who understands where the Foundation Trust is going, and who can blme them? So Members of the Public vote with their feet. Our Membership is about 7,000 out of a population of 500,000 in Somerset. The public want to know why they should bother, and I struggle to tell them.
But lets look forward! The concept of the Foundation Trust and its accountability to our local community fires and excites me as much as it ever did, and I believe that we have to go back to basics and look at our vision and how we communicate that vision. Well, the Big Society is surely a good start, and the idea of local accountability, says what I want to say.Furthermore. it does seem to be recognised and is a flag for people to follow. OK, pretty basic stuff, but we are not looking for a Guardian editorial here. Give it a chance, and think about communicating our ideas. Then we can really move forward!

Richard Blogger

Comment date
29 October 2010
Please get it right. Circle Health is NOT an "employee-owned co-operative". There are some policy makers trying to make us believe that they are, since that is their plan for the entire NHS.

This is copied from Circle's own website:



Circle is structured as a partnership of clinicians and other professionals. Being a partner means you share in the ownership of Circle, with shareholder voting rights to help direct the company.

* 49.9% of Circle is owned by Circle Partnership Ltd, which is owned by everyone who works in clinical services, directly or indirectly and at every level.
* 50.1% is owned by Circle International plc. This is the investment vehicle that blue chip City institutional investors have subscribed to for shares by providing the capital for Circle. They ensure that any refinancing is achieved without diluting partners' 49.9% ownership.
* The investment needed to buy land and build hospitals, clinics and invest in infrastructure is raised by Health Properties Ltd, a separate business.

Every year from 2003-2015, up to ten million shares will be available for allocation to partners until 100 million shares have been issued.

===end quote===

So a minority (49.9%) is owned by employees. The MAJORITY is owned by City investors. And Health Properties Ltd own the hospitals, not Circle.

I am getting rather sick of hearing the misinformation repeated by politicians with an axe to grind (and by people like KF, who should know better) that Circle is a "co-op" and that it is "employee-owned". The majority investors are City investors, Circle is private healthcare pure and simple.

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